ᖹᡂ 21 ᖺᗘ ⥲ᣓ◊✲ሗ࿌᭩ 㸦 21 ᣦ 117㸧 ኱ ື ⬦ ⒗ ࡢ ⑓ ែ ゎ ᫂ ࡜ ↓ ౵ く ἞ ⒪ ࡢ ⮫ ᗋ ヨ㦂㸫ᑠᚄ⒗ࢆ⏕ά⩦័⑓࡜ᤊ࠼ࡿ᪂ࡓ࡞ྲྀࡾ⤌ࡳ㸫 ୺௵◊✲⪅㸸ᮌᮧኊ௓ 㸯㸬┠ⓗ ⛅⏣సክࠊᑿ⃝┤⨾ࠊᚿከ⏤Ꮥࠊㅖᒸ㒔ࠊ ᑠཱྀᚄ኱ື⬦⒗ࡣ⌧ᅾ἞⒪᪉ἲࡀ࡞ࡃࠊ↓⑕ Ლᑿ⿱㸸ᅜ❧ᅜ㝿་⒪ࢭࣥࢱ࣮ ≧ࡢࡓࡵ₯ᅾⓗ࡞⑕౛ᩘࡣከ࠸࡜ᛮࢃࢀࡿࠋᮏ ◊✲࡛ࡣࠊ኱ື⬦⒗ࢆ⏕ά⩦័⑓ࡢᯟ⤌ࡳ࡛ᤊ 㸱㸬◊✲ᡂᯝ ࠼┤ࡋࠊ⑓ែゎᯒࠊᣑ኱ᅉᏊࡢ㏣ồࢆ⾜࠸ࠊ⒗ ᖹᡂ ᖺ ᭶㺂೔⌮ጤဨ఍࠿ࡽࡢᢎㄆ㏻ ᣑ኱ࢆᢚไࡍࡿ἞⒪࡟◊✲ࢆ㐍ࡵࡓ࠸ࠋࡑࡢࡓ ▱ࢆཷࡅ㺂ᙜ㝔࠾ࡼࡧᮾி་⛉኱Ꮫࡢヱᙜ⑕౛ ࡵ࡟ࠊࡲࡎᑠཱྀᚄ኱ື⬦⒗ࡢ⮬↛Ṕ㸦ᣑ኱㏿ᗘࠊ ࡢⓏ㘓ࢆ㛤ጞࡋࡓࠋᑠᚄ⒗ࡢᑐ㇟⪅ࡣ㺂Ᏻᐃࡋࡓ ྛື⬦◳໬ಁ㐍ᅉᏊࡢᙳ㡪㸧ࢆศᯒࠊሗ࿌ࡉࢀ ≧ែ࡛⤒㐣ほᐹ୰ࡀከࡃ㺂㏻㝔㛫㝸ࡶ㛗࠸ࡓࡵ ࡚࠸ࡿ⑓ែࢆ⾲ࡍྛ✀ᅉᏊ㸦)'*Ѹ3(7ࠊࣂ࢖࣐࢜ ⌧ᅾᙜࢭࣥࢱ࣮ศ࡜ࡋ࡚ ྡࢆⓏ㘓ࡋ࡚࠸ࡿࠋ ࣮࣮࢝➼㸧࡜ࡢ㛵㐃ࢆ᳨ウࠊᑠཱྀᚄ኱ື⬦⒗ࡢ 㟁ヰ➼࡛ㄝ᫂㺂ᇶᮏⓗ࡟ᢎㅙࢆᚓ㺂ḟᅇ᮶㝔᫬ ᣑ኱せᅉࢆ᥈ồࡋࡓ࠸ࠋࡉࡽ࡟↓౵く㺃పࢥࢫࢺ ࡟ṇᘧᢎㅙ㺂᥇⾑➼ࢆྵࡵ ᘬࡁ⥆ࡁᮾி་⛉኱Ꮫࡢ⑕౛ࢆຍ࠼㺂 ౛⛬ ἞⒪ࢆヨࡳࠊᝈ⪅ࡢᏳᚰࠊ་⒪㈝๐ῶ࡟㈉⊩ࡋ ࡓ࠸ࠋ ᗘࡀ㺒㺻㺢㺶㺎࡟ྥࡅ‽ഛ୰࡛࠶ࡿࠋ 㸰㸬◊✲⌜ࡢᵓᡂ ᚑࡗ࡚㺂 ౛ࡢ +LVWRULFDO'DWDᩘᖺ๓࠿ࡽ 㸦୺௵◊✲⪅㸸ᡤᒓ㸧 ࡢ㺂୺࡟ &7 ࡟ࡼࡿ⒗ᚄࡢኚ໬࡟ࡼࡿࠕᑠᚄ⒗ࡢ ᮌᮧኊ௓㸸ᅜ❧ᅜ㝿་⒪ࢭࣥࢱ࣮㺂㝔㛗ᚰ⮚⾑ ⮬↛Ṕㄪᰝࠖࡀᚓࡽࢀ࡚࠸ࡿࡀ㺂⾑Ύ㺡㺦㺐㺚㺻 &㺂 ⟶እ⛉ )'*3(7 ➼ࡢࠕ᪂ࡓ࡞⑓ែデ᩿ἲࡢ⮫ᗋ◊✲ࠖ 㸦ศᢸ◊✲⪅㸸ᡤᒓ㸧 ࡟ࡣ⮳ࡗ࡚࠸࡞࠸ࠋࡇࢀࡽࡣ௒ᚋ࡟᭱኱㝈ࡢດ ᘅỤ㐨᫛㸸ᅜ❧ᅜ㝿་⒪ࢭࣥࢱ࣮㸦ᚠ⎔ჾෆ⛉㸧 ຊࢆࡋ࡚㐩ᡂࡍࡿணᐃ࡛࠶ࡿࠋ 㔝⏣ගᙪ㸸ྠ㸦⢾ᒀ⑓㺃௦ㅰ㺃ෆศἪ⛉㸧 ⑕౛㸸⌧ᅾᚓࡽࢀ࡚࠸ࡿ 'DWD ࢆ⾲㸯࡟♧ࡍࠋ ⶈᑿ㔠༤㸸ྠ㸦ᨺᑕ⥺⛉㸧 +LVWRULFDO'DWD ࡜ࡋ࡚ࠊ)ROORZ8S ᮇ㛫ࡣ㸯ᖺ ❑⏣࿴㞝㸸ྠ㸦ᨺᑕ⥺⛉㸧 ᮍ‶࠿ࡽ ᖺࡲ࡛࠶ࡾࠊྛࠎࡢ⒗ᚄࡢኚ໬㸦ቑ 㐲⸨ஂᏊ㸸ྠ㸦⮫ᗋ⑓⌮ᐊ㸧 ኱㸧ࡣ⾲ࡢ㏻ࡾ࡛࠶ࡗࡓࠋ⭡㒊࡛ࡢ PP ௨ୖࠊ 㔜ᯇ ᏹ㸸ᮾி་⛉኱Ꮫ➨஧እ⛉ ⬚㒊࡛ࡢ PP ௨ୖࡢ )ROORZ8S ࡜ẚ࡭ࠊ⒗ᚄࡢ ௒୰ᜤᏊ㸸୕㔜኱Ꮫᐇ㦂⑓⌮Ꮫ ᣑ኱㏿ᗘࡣࡺࡗࡃࡾ࡛᭷ࡿࡇ࡜ࡀᨵࡵุ࡚᫂ࡋ 㟷ᮌᾈᶞ㸸ஂ␃⡿኱Ꮫᚠ⎔ჾෆ⛉ ࡓࠋࡲࡓࠊ⤒㐣୰࡟⅖⑕㸦ឤᰁ㸧ࡀຍ࿡ࡋࡓ⑕ ྜྷᮧ⪔୍㸸ᒣཱྀ኱ᏛศᏊ⬦⟶⑓ែᏛ ౛ࡣࠊࡑࡢ⅖⑕άືᮇ࡟⒗ᚄࡢᛴᛶᣑ኱ࡀㄆࡵ 㸦◊✲༠ຊ⪅㸸ᡤᒓ㸧 ࡽࢀࡓࠋ ᶔ⏣ගኵࠊᒸᓮಟࠊ⏣୰⏤฼Ꮚࠊ๪ᓥὒ⾜ࠊ ᅗ㸦⑕౛㸱㸧㸸 ṓ⏨ᛶࠊෙື⬦ࣂ࢖ࣃࢫᡭ ⏣Ᏺ၏୍ࠊୖᮧ᐀ᘯࠊᒣᓮᬛᘯࠊ㛛⬥ᣅࠊ ⾡᪋⾜᫬ࡼࡾ &7 ࡟ࡼࡿ኱ື⬦ࡢ 'DWD ࡀ࠶ࡾ⭡ ᰘ⏣⣧Ꮚࠊಖᆏⱱࠊ㈡ᓥಇ㝯ࠊ⚟⏣ᑦྖࠊ 㒊኱ື⬦ࡢ㝈ᒁゎ㞳ࢆㄆࡵ⤒㐣ࢆほᐹࠊ ᖺ - 205 - ࡟⭡③ࠊ⭡㒊ࡢᅽ③ࡀฟ⌧ࠊ&7 ୖࠊ⒗࿘ᅖࡢ⅖ ࡇࡢᡤぢ࠿ࡽᒁᡤ࡟㉳ࡁࡓάືᛶࡢ⅖⑕⑓ែࡀࠊ ⑕ᡤぢ࡜⒗ᚄࡢቑ኱ࢆㄆࡵࠊ⅖⑕ࡀⴠࡕ╔࠸ࡓ ⒗ᚄࡢᣑ኱࡟኱ࡁࡃ㛵୚ࡋ࡚࠸ࡿ࡜ゝ࠺ࡇ࡜ࡀ ᚋࡣᣑ኱ࡶⴠࡕ╔࠸ࡓࠋ ࡛ࡁࡿࠋᚑࡗ࡚ࠊᑠᚄ⒗࡟࠾࠸࡚ࡶࠊ⅖⑕ࡢ᭷ ᅗ㸦⑕౛㸲㸧㸸 ṓ⏨ᛶࠊ ᖺ㐲఩ᘪ㒊ࡢ ↓ࠊ⅖⑕࡟ࡼࡾⓎ⌧ࡍࡿ⣽⬊እ࣐ࢺࣜࢵࢡࢫ⺮ ഃ᪉࡬✺ฟࡍࡿᄞ≧⒗㸦ṇᖖᚄ PP ࡀ PP ࡜ ⓑ࡛࠶ࡿࢸࢿ࢖ࢩࣥ & ࡢᒁᡤࡲࡓࡣ⾑Ύෆ⃰ᗘࠊ ⒗ᚄ࡛ࡣᑐ㇟࡟࡞ࡽ࡞࠸ࡀࠊᙧ≧ࡀᄞ≧⒗㸧ࡣࠊ ⅖⑕ࢆ཯ᫎࡍࡿ )'*3(7 ࡢᡤぢ࡟ࡼࡾ㧗ឤᗘ࡛ 㸳ᖺ㛫ࡢ⤒㐣୰඲ࡃᙧ≧࡟ኚ໬↓ࡃࠊ⒗ᚄࡶᣑ ᒁᡤࡢ⅖⑕ࢆุᐃࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࢀࡤࠊᑠ ኱ࢆㄆࡵ࡚࠸࡞࠸ࠋᮏ౛ࡣࠊ⾑ᾮ 'DWD ୖࡣ㧗⬡ ᚄ⒗ࡢ⮬↛⤒㐣࡜ࡢẚ㍑᳨ウ࡟ࡼࡗ࡚ࠊணᚋࢆ ⾑⑕ࢆㄆࡵࡿࡀࠊ㐠ື㸦㺡㺤㺛㸧ࢆẖ᪥⾜࠸ࠊ㐠ື ண ࡍࡿࡇ࡜࡟㐃࡞ࡿ㺨㺼㺐㺓㺭㺎㺔㺎࡜ࡋ࡚ࡢព⩏ࢆ ⒪ἲࡢຠᯝࢆᛮࢃࡏࡿ⑕౛࡛࠶ࡿࠋ ド࡛᫂ࡁࡿྍ⬟ᛶࡀ࠶ࡿࠋ 㸲㸬⪃ᐹ࡜ࡲ࡜ࡵ ࡲࡓࠊື⬦⒗࡛ୖグ㺨㺼㺐㺓㺭㺎㺔㺎ࡀ㧗್ࢆ♧ࡍ౛ ኱ື⬦⒗ࡣ኱ື⬦ቨࡢᒁᡤⓗ࡞⬤ᙅ໬࡜ ࡟࠾࠸࡚ࠊ⏕ά⩦័⑓ࡢ἞⒪ࠊ㐠ື⒪ἲ➼ࢆ⾜ ᚄࡢᣑ኱ࡀ↓⑕≧ࡢࡲࡲ࡟㐍⾜ࡋࠊࡘ࠸࡟ࡣ◚ ࠸ࠊ㺨㺼㺐㺓㺭㺎㺔㺎ࡢᨵၿࡀぢࡽࢀࠊ⒗ᚄࡢᣑ኱㺃㐍ᒎ ⿣࣭✺↛Ṛ࡟⮳ࡿ⑌ᝈ࡛࠶ࡿࠋ἞⒪ἲࡣࠊ◚⿣ ࡀ཰ࡲࢀࡤࠊ἞⒪ࡢຠᯝุᐃࡢᣦᶆ࡜ࡋ࡚ࡢព ༴㝤ᗘࡢ㧗࠸኱ᚄ⒗࡟ᑐࡍࡿ㛤⬚࣭㛤⭡࡟ࡼࡿ ⩏ࡀุ᫂ࡍࡿࠋ ேᕤ⾑⟶⨨᥮⾡࠿ࠊ㺛㺡㺻㺢㺖㺼㺵㺪㺢ࢆෆᤄࡍࡿ⾑⟶ ኱ື⬦⒗ࡢ⑓ែ㺃άືᛶࢆホ౯ࡍࡿ㺨㺼㺐㺓㺭㺎㺔㺎 ෆ἞⒪⾡ࡢࡳ࡛࠶ࡿࠋ⌧ᅾ⒗ᚄࡢ㐍⾜ࢆᢚ࠼ࡿ ࡜ࡋ࡚ࠊ㺡㺦㺐㺚㺻㹁ࠊ)'*3(7 ࡢព⩏ࡀド᫂ࡉࢀࢀ ἞⒪ἲࡣ↓ࡃࠊྠ᫬࡟⒗ࡢཱྀᚄ࠾ࡼࡧᙧែ௨እ ࡤࠊ኱ཱྀᚄ኱ື⬦⒗ࡢ἞⒪ࡢ㐺ᛂࠊ⾡ᚋࡢ⑓ែ ࡟◚⿣༴㝤ᗘࢆホ౯ࡍࡿ⑓ែデ᩿ἲࡶ↓࠸ࠋ ࡔࡅ࡛࡞ࡃࠊ⌧ᅾ࡛ࡣ἞⒪ࡢᣦᶆࡀ↓ࡃࠊணᚋ ⒗ᚄ㺃ᙧែࡣ⌧ᅾࡢᡤࠊື⬦⒗ࡢணᚋࢆつᐃࡍ ࡢุᐃࡶ୙᫂☜࡞ࠊᑠཱྀᚄࡢື⬦⒗ࡢ⑓ែࢆホ ࡿ᭱ࡶಙ㢗࡛ࡁࡿᅉᏊ࡛࠶ࡿࠋࡋ࠿ࡋ࠶ࡿ⛬ᗘ ౯ࡍࡿࡇ࡜ࡀྍ⬟࡜࡞ࡾࠊ἞⒪ࡢ㐺ᛂ㺃ホ౯ࠊண ࡢཱྀᚄ࡟࡞ࡿ࡜ /DSODFH ࡢἲ๎࡟ᚑ࠸ᣑ኱㏿ᗘ ᚋࡢண ࠊ➼⒗ᣑ኱㺃◚⿣ࡢண㜵ࢆྵࡵࠊ኱ື⬦ ࡶ㏿ࡃ࡞ࡿࡇ࡜ࡣᣦ᦬ࡉࢀ࡚࠸ࡿࡀࠊᑠཱྀᚄࡢ ⒗ࡢ἞⒪࡟኱ࡁࡃ㈉⊩ࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࡿࠋ ⒗ࡀ࡝ࡢࡼ࠺࡞⤒㐣ࢆ࡜ࡿ࠿ࡣุ᫂ࡋ࡚࠸࡞࠸ࠋ ᪩ᛴ࡟ࠊ᥇⾑ࠊ)'*3(7 ࢆྵࡵࠊᮏ◊✲ࢆ㐍 ⮫ᗋ⤒㦂࠿ࡽࠊ⒗ᚄࡀᑡࡋࡎࡘᣑ኱ࡍࡿ౛࡜ࠊ ࡵ࡚࠸ࡁࡓ࠸ࠋ ඲ࡃኚ໬ࡋ࡞࠸౛ࡀ࠶ࡿࡇ࡜ࡶ▱ࡽࢀ࡚࠸ࡿࡀࠊ ࡑࡢᕪࡀ࡝ࡇ࡟࠶ࡿࡢ࠿ࡣᐃ࠿࡛ࡣ࡞࠸ࠋᑠᚄ ⒗ࢆ㐍⾜㺃ᣑ኱ࡉࡏࡿせᅉࡀุ᫂ࡍࢀࡤࠊᣑ኱ࢆ 㜼Ṇࡍࡿྍ⬟ᛶࡶ࡛࡚ࡃࡿࡇ࡜࡟࡞ࡿࠋ ⌧ẁ㝵࡛ ౛࡜࠸࠺ᑡᩘ࡛ࡣ࠶ࡿࡀࠊᣑ኱ഴ ྥࡀࡺࡗࡃࡾ࡛࠶ࡿࡇ࡜ࡣᚑ᮶ࡢ༳㇟࡟୍⮴ࡋ ࡚࠸ࡿࠋࡑࡢ୰࡛ࠊ⤒㐣୰࡟⅖⑕㸦ឤᰁ㸽㸧ࢆ ేⓎࡋࡓ౛࡛ࡣ⒗ᚄࡢᛴᛶᣑ኱ࢆㄆࡵࠊࡑࡢ⅖ ⑕ࡀᾘ㏥ࡋࡓᚋࡣ⒗ᚄࡢኚ໬ࡶⴠࡕ╔࠸࡚࠸ࡿࠋ - 206 - ⾲ ኱ື⬦⒗ࡢ⮬↛Ṕ 1R ᖺ㱋 ᛶู ⒗ᙧែ ⌧ᅾࡲ࡛ࡢ⒗ᚄኚ໬ ഛ⪃ 㺪㺉㺹㺎㺏㺍㺪㺽 ᮇ㛫 ṓ ⏨ᛶ ⭈ື⬦ୗ⣳㗽⒗ PPЍPP ᖺ ึデ᫬⅖⑕ᛶ኱ື⬦⒗ࠋ ⏨ᛶ ⭈ື⬦ୗ⣳㗽⒗ PPЍPP ᖺ ⏨ᛶ ⭈ື⬦ୗ⣳㗽⒗ PPЍPP ᖺ ⤒㐣୰࡟⅖⑕⒗ࡢᙧែࠋ ⏨ᛶ 㐲఩ᘪ㒊ᄷ≧⒗ PPЍPP ᖺ ⏨ᛶ 㐲఩ᘪ㒊ᄷ≧⒗ PPЍPP ᖺ ⏨ᛶ ⭈ື⬦ୗᄷ≧⒗ PPЍPP ᖺ 㝈ᒁゎ㞳ࢆక࠺ࠋ ⏨ᛶ 㐲఩ᘪ㒊⣳㗽⒗ PPЍPP ᖺ ⭈ື⬦ୗ⣳㗽⒗ ⏨ᛶ 㐲఩ᘪ㒊ᄷ≧⒗ PPЍPP ᖺᮍ‶ ⏨ᛶ 㐲఩ᘪ㒊⣳㗽⒗ PP ᖺᮍ‶ PPЍPP ᖺᮍ‶ ⭈ື⬦ୗ⣳㗽⒗ ⏨ᛶ ⭈ື⬦ୗ⣳㗽⒗ ⑕౛ ṓ ⏨ᛶ ⭈ື⬦ୗ⅖⑕⒗㸦㝈ᒁゎ㞳ࢆక࠺㸧 2009ᖺ 2008ᖺ 2004ᖺ 2007ᖺ ᭱኱▷ᚄ 23mm ᭱኱▷ᚄ 24mm ᭱኱▷ᚄ35mm ᭱኱▷ᚄ35mm ⭡㒊䛾㝈ᒁゎ㞳䛻ᑐ䛧䛶䝣䜷䝻䞊䜰䝑䝥㛤ጞᩘᖺᚋ䛻䚸⭡③䛜ฟ⌧䛧CT᪋⾜䛧䛯䛸䛣䜝䚸 እ⭷ഃ䛾⫧ཌ䜔࿘ᅖ䛾⬡⫫⧊䛾ẟ⩚❧䛱➼䛾⅖⑕ᛶኚ໬䛸䚸㝈ᒁゎ㞳䛾㐍⾜䛚䜘䜃 ⒗ᚄ䛾ᣑ኱䜢ㄆ䜑䛯䛜⅖⑕䛾⤊ᜥ䛸䛸䜒䛻ᣑ኱ഴྥ䛿೵Ṇ䛧䛯䚹 - 207 - ⑕౛4㻌 65ṓ㻌 ⏨ᛶ㻌㐲఩ᘪ㒊ᄷ≧⒗ 2004ᖺ 2008ᖺ 2006ᖺ 2009ᖺ ᭱኱▷ᚄ 38mm ᭱኱▷ᚄ 38mm ᭱኱▷ᚄ 39mm 2004ᖺ䛻㐲఩ᘪ㒊ᄷ≧⒗䜢ᣦ᦬䛥䜜௨ᚋ䝣䜷䝻㸳㸬୺ࡓࡿ◊✲Ⓨ⾲ཬࡧ≉チ - 208 - ᭱኱▷ᚄ 39mm Study on the growth of sub-clinical size Aortic Aneurysm, analyzed as a disease of metabolic syndrome. Sosuke Kimura1, Michiaki Hiroe1, Mitsuhiko Nda1, Kanehiro Hasuo1, Kazuo Kubota1, Hisako Endo1, Hiroshi Shigematsu2, Kyouko Imanaka3, Hiroki Aoki4, Kouichi Yoshimura5. National Center for Global Health and Medicine1, Tokyo Medical College2, Mie University3, Kurume University4, Ymaguchi University5. and CT data are analyzed. Introduction: Generally, Abdominal Aortic Aneurysm (AAA) is a life Among the ten cases of small aneurysm, 3 cases are threatening disease, especially in the ruptured case, distal arch thoracic aorta aneurysm and 2 cases have and usually until the time of rupture, there is no both thoracic and abdominal aorta aneurysm. Seven symptom. But today, there is no way of treatment for cases of small size AAA have been followed with the CT the small size AAA, because of no indication for the scan. At the time to start the follow up, the diameter of surgical operation nor the catheter “Stent Grafting”. small size AAA was 28.7 ± 4.46mm (mean ± S.D.). The We caught this small size AAA in a framework of the follow up period is 0 to 10years (3.7 ± 3.77years). The metabolic syndrome. In this study, we follow up its size average growth rate of the diameter is 0.78 ± by CT, analyze it with the biomarkers which are the 0.91mm/year. factors of the sclerosis, inflammation and others related But in two cases which showed an inflammatory to the growth of the diameter. The aim of this study is to response during this period, the speed of the diameter find out the factors of the growth of AAA, and may growth was not even yearly. It was extraordinary high control its growth, which means to control the disease during the inflammatory active phase. In the case 66 itself, in the future. year old male, the follow up period was 6 years from 2004 to 2009, the diameter was 23mm at 2004, 35mm at 2009. In 2007, he showed a fever and abdominal pain Methods: The natural course, the growth rate of the size of small AAA will be calculated from the historical data for about 2 months. During that time, the diameter grew up from 23 to 35mm. followed by CT. The biomarkers, which have been reported in the relations to AAA, such as CRP, MMP, tenascin-C are checked. The local inflammation factor is Discussion: According to the reports, the size of the small AAA is examined by PET-CT. growing under the very slow and same speed. In our In case of operation, pathological examination on the series, some cases grow up fast and some others slow excised aortic wall with additional staining for almost keeping the same size for ten years, which tenascin-C and MMP9 is also done. showed us that there is a specific condition to promote the enlargement. One of the factors which accelerates the growth with uneven high speed was an Results: The study was actually started at the end of inflammatory episode during the follow up. November 2009, because the ethical committee More than a hundred cases should be needed to accepted on the same month. Ten cases were registered discuss this study, analyzing with other factors like at the end of January 2010. Only the historical clinical biomarkers, PET-CT and others. - 209 - 㸦 ᣦ 㸧⥲ᣓࠊᑠᚄ⒗ࡢ⮬↛Ṕࠊ⑓ែデ᩿ ศᢸ◊✲⪅㸸ᮌᮧኊ௓ 㸯㸬┠ⓗ ࣭&7 ࡟ࡼࡿ⒗ᚄィ ್ࠊ)'*3(7 ࡟ࡼࡿ⒗ෆ ᑠཱྀᚄ኱ື⬦⒗ࡣ⌧ᅾ἞⒪᪉ἲࡀ࡞ࡃࠊ↓⑕≧ PD[689 ࡢィ ࡢࡓࡵ₯ᅾⓗ࡞⑕౛ᩘࡣከ࠸࡜ᛮࢃࢀࡿࠋᮏ◊✲ ࣭᥇⾑ࢫࢱࢹ࢕ᑐ㇟ࡢ ࣨ᭶௨ෆࡢ⤖ᯝࠊྍ ࡛ࡣࠊ኱ື⬦⒗ࢆ⏕ά⩦័⑓ࡢᯟ⤌ࡳ࡛ᤊ࠼┤ࡋࠊ ⬟࡞㝈ࡾࢫࢱࢹ࢕Ⓩ㘓᫬┤㏆ ⑓ែゎᯒࠊᣑ኱ᅉᏊࡢ㏣ồࢆ⾜࠸ࠊ⒗ᣑ኱ࢆᢚไ &UHࠊ7&KRࠊ+'/&KRࠊ/'/&KR)ULHGZDOG ࡍࡿ἞⒪࡟◊✲ࢆ㐍ࡵࡓ࠸ࠋࡑࡢࡓࡵ࡟ࠊࡲࡎᑠ ࡢィ⟬ᘧྍࠊ7*ࠊ+E$Fࠊ&53ࡲࡓࡣ ཱྀᚄ኱ື⬦⒗ࡢ⮬↛Ṕ㸦ᣑ኱㏿ᗘࠊྛື⬦◳໬ಁ 㧗ឤᗘ &53ࠊࢸࢿ࢖ࢩࣥ &ࠊ003ࠊ 㐍ᅉᏊࡢᙳ㡪㸧ࢆศᯒࠊሗ࿌ࡉࢀ࡚࠸ࡿ⑓ែࢆ⾲ 003ࠊ)'3ࠊ' ࢲ࢖࣐࣮ ࡍྛ✀ᅉᏊ㸦)'*Ѹ3(7ࠊࣂ࢖࣐࣮࣮࢜࢝➼㸧࡜ࡢ ࣭ၥデ㌟యᡤぢ࢝ࣝࢸ 㛵㐃ࢆ᳨ウࠊᑠཱྀᚄ኱ື⬦⒗ࡢᣑ኱せᅉࢆ᥈ồࡋ ࡓ࠸ࠋࡉࡽ࡟↓౵く㺃పࢥࢫࢺ἞⒪ࢆヨࡳࠊᝈ⪅ 㸱㸬◊✲ᡂᯝ ࡢᏳᚰࠊ་⒪㈝๐ῶ࡟㈉⊩ࡋࡓ࠸ࠋ ᖹᡂ ᖺ ᭶㺂೔⌮ጤဨ఍࠿ࡽࡢᢎㄆ㏻▱ࢆ ཷࡅ㺂ᙜ㝔࠾ࡼࡧᮾி་⛉኱Ꮫࡢヱᙜ⑕౛ࡢⓏ㘓㸰㸬᪉ἲ ࢆ㛤ጞࡋࡓࠋᑠᚄ⒗ࡢᑐ㇟⪅ࡣ㺂Ᏻᐃࡋࡓ≧ែ࡛ ᑠཱྀᚄ⒗ࢆⓏ㘓ࡋࠊྛ✀ 'DWD ࢆ᳨⣴ࡋ࡞ࡀࡽࠊ ⤒㐣ほᐹ୰ࡀከࡃ㺂㏻㝔㛫㝸ࡶ㛗࠸ࡓࡵ⌧ᅾᙜࢭ ⮬↛Ṕࢆㄪᰝࡍࡿࡇ࡜࡟㛵ࡋࠊ௨๓࠿ࡽ⤒㐣ほᐹ ࣥࢱ࣮ศ࡜ࡋ࡚ ྡࢆⓏ㘓ࡋ࡚࠸ࡿࠋ㟁ヰ➼࡛ ࢆࡋ࡚࠸ࡿ⑕౛ࡢ㹁㹒࡟ࡼࡿ⒗ᚄࢆ +LVWRULFDO ㄝ᫂㺂ᇶᮏⓗ࡟ᢎㅙࢆᚓ㺂ḟᅇ᮶㝔᫬࡟ṇᘧᢎㅙ㺂 'DWD ࡜ࡋ᳨࡚⣴ࡋࡓࠋ ᥇⾑➼ࢆྵࡵᘬࡁ⥆ࡁᮾி་⛉኱Ꮫࡢ⑕౛ࢆຍ 㑅ᢥᇶ‽㸸 ṓ௨ୖ ṓᮍ‶࡛ &7࣭05, ᳨ᰝ࠾ ࠼㺂 ౛⛬ᗘࡀ㺒㺻㺢㺶㺎࡟ྥࡅ‽ഛ୰࡛࠶ࡿࠋ ࡼࡧ㉸㡢Ἴ᳨ᰝ➼࡛኱ື⬦⒗࡜デ᩿ࡉ ࢀࠊᙜ㝔㹁㹒࡟࡚ヲ⣽࡞ィデ᩿ࡀᚓࡽࢀࡓᝈ⪅ࠋ ᚑࡗ࡚㺂 ౛ࡢ +LVWRULFDO'DWDᩘᖺ๓࠿ࡽࡢ㺂 ኱ື⬦⒗࡜ࡣື⬦ࡢṇᖖᚄࡢ ಸ௨ୖࡢᣑ኱ ୺࡟ &7 ࡟ࡼࡿ⒗ᚄࡢኚ໬࡟ࡼࡿࠕᑠᚄ⒗ࡢ⮬↛ 㸦⣳㗽ᆺ㸸⬚㒊ࡣ PP ௨ୖ⭡㒊ࡣ PP ௨ୖ㸧 Ṕㄪᰝࠖࡀᚓࡽࢀ࡚࠸ࡿࡀ㺂⾑Ύ㺡㺦㺐㺚㺻 &㺂)'*3(7 ࠶ࡿ࠸ࡣᄷ≧ࡢ✺ฟᙧែࢆࡳ࡜ࡵࡿࡶࡢ࡜ᐃ⩏ ➼ࡢࠕ᪂ࡓ࡞⑓ែデ᩿ἲࡢ⮫ᗋ◊✲ࠖ࡟ࡣ⌧ᅾ⮳ ࡍࡿࠋ ࡗ࡚࠸࡞࠸ࠋࡇࢀࡽࡣ௒ᚋ࡟᭱኱㝈ࡢດຊࢆࡋ࡚ 㝖እᇶ‽㸸㐩ᡂࡍࡿணᐃ࡛࠶ࡿࠋ ࣭㧗⾑ᅽ㺂⢾ᒀ⑓࡞࡝༴㝤ᅉᏊࡢ⟶⌮㺂༠ຊࡀ୙༑ ⑕౛㸸⌧ᅾᚓࡽࢀ࡚࠸ࡿ 'DWD ࢆ⾲࡟♧ࡍࠋ ศ࡞ᝈ⪅ࠊ +LVWRULFDO'DWD ࡜ࡋ࡚ࠊ)ROORZ8S ᮇ㛫ࡣ㸯ᖺ ࣭኱ື⬦⒗◚⿣ᝈ⪅ࠊ ᮍ‶࠿ࡽ ᖺࡲ࡛࠶ࡾࠊྛࠎࡢ⒗ᚄࡢኚ໬㸦ቑ ࣭⭡㒊኱ື⬦⒗㸹⒗ᚄ FP ௨ୖᝈ⪅ ኱㸧ࡣ⾲ࡢ㏻ࡾ࡛࠶ࡗࡓࠋ⭡㒊࡛ࡢ PP ௨ୖࠊ ࣭ዷፎᝈ⪅ࠊ㏱ᯒᝈ⪅ ⬚㒊࡛ࡢ PP ௨ୖࡢ )ROORZ8S ࡜ẚ࡭ࠊ⒗ᚄࡢ ࣭ㄝ᫂ࡀ⌮ゎ࡛ࡁ࡞࠸ᝈ⪅ ᣑ኱㏿ᗘࡣࡺࡗࡃࡾ࡛᭷ࡿࡇ࡜ࡀᨵࡵุ࡚᫂ࡋ ୰Ṇᇶ‽ ࡓࠋࡲࡓࠊ⤒㐣୰࡟⅖⑕㸦ឤᰁ㸧ࡀຍ࿡ࡋࡓ⑕౛ ࣭௒ᅇࡢࢫࢱࢹ࢕࡬ࡢཧຍࢆ㎡㏥ࡋࡓ࠸࡜ࡢ ࡣࠊࡑࡢάືᮇ࡟⒗ᚄࡢᛴᛶᣑ኱ࡀㄆࡵࡽࢀࡓࠋ ⏦ࡋฟࠊྠពࡢ᧔ᅇࡀ࠶ࡗࡓሙྜࡣ୰Ṇࠋ ࣭⒗ᚄࡢᣑ኱㸦ᡭ⾡ࡢ㐺ᛂࢆ‶ࡓࡍሙྜ㸧㸲㸬⪃ᐹ࡜ࡲ࡜ࡵ ࣭ᡭ⾡➼ࠊ἞⒪ࡀ⾜ࢃࢀࡓሙྜ ⒗ᚄ㺃ᙧែࡣ⌧ᅾࡢᡤࠊື⬦⒗ࡢணᚋࢆつᐃࡍ ほᐹ࠾ࡼࡧ᳨ᰝ㡯┠ ࡿ᭱ࡶಙ㢗࡛ࡁࡿᅉᏊ࡛࠶ࡿࠋࡋ࠿ࡋ࠶ࡿ⛬ᗘࡢ - 210 - ཱྀᚄ࡟࡞ࡿ࡜ /DSODFH ࡢἲ๎࡟ᚑ࠸ᣑ኱㏿ᗘࡶ ᾘ㏥ࡋࡓᚋࡣ⒗ᚄࡢኚ໬ࡶⴠࡕ╔࠸࡚࠸ࡿࠋࡇࡢ ㏿ࡃ࡞ࡿࡇ࡜ࡣᣦ᦬ࡉࢀ࡚࠸ࡿࡀࠊᑠཱྀᚄࡢ⒗ࡀ ᡤぢ࠿ࡽᒁᡤ࡟㉳ࡁࡓάືᛶࡢ⅖⑕⑓ែࡀࠊ⒗ᚄ ࡝ࡢࡼ࠺࡞⤒㐣ࢆ࡜ࡿ࠿ࡣุ᫂ࡋ࡚࠸࡞࠸ࠋ⮫ᗋ ࡢᣑ኱࡟኱ࡁࡃ㛵୚ࡋ࡚࠸ࡿ࡜ゝ࠺ࡇ࡜ࡀ࡛ࡁ ⤒㦂࠿ࡽࠊ⒗ᚄࡀᑡࡋࡎࡘᣑ኱ࡍࡿ౛࡜ࠊ඲ࡃኚ ࡿࠋᚑࡗ࡚ࠊᑠᚄ⒗࡟࠾࠸࡚ࡶࠊ⅖⑕ࡢ᭷↓ࠊ⅖ ໬ࡋ࡞࠸౛ࡀ࠶ࡿࡇ࡜ࡶ▱ࡽࢀ࡚࠸ࡿࡀࠊࡑࡢᕪ ⑕࡟ࡼࡾⓎ⌧ࡍࡿ⣽⬊እ࣐ࢺࣜࢵࢡࢫ⺮ⓑ࡛࠶ ࡀ࡝ࡇ࡟࠶ࡿࡢ࠿ࡣᐃ࠿࡛ࡣ࡞࠸ࠋᑠᚄ⒗ࢆ㐍 ࡿࢸࢿ࢖ࢩࣥ & ࡢᒁᡤࡲࡓࡣ⾑Ύෆ⃰ᗘࠊ⅖⑕ࢆ ⾜㺃ᣑ኱ࡉࡏࡿせᅉࡀุ᫂ࡍࢀࡤࠊᣑ኱ࢆ㜼Ṇࡍ ཯ᫎࡍࡿ )'*3(7 ࡢᡤぢ࡟ࡼࡾ㧗ឤᗘ࡛ᒁᡤࡢ ࡿྍ⬟ᛶࡶ࡛࡚ࡃࡿࡇ࡜࡟࡞ࡿࠋ ⅖⑕ࢆุᐃࡍࡿࡇ࡜ࡀྍ⬟࡛࠶ࢀࡤࠊᑠᚄ⒗ࡢ⮬ ⌧ẁ㝵࡛ ౛࡜࠸࠺ᑡᩘ࡛ࡣ࠶ࡿࡀࠊᣑ኱ഴ ↛⤒㐣࡜ࡢẚ㍑᳨ウ࡟ࡼࡗ࡚ࠊணᚋࢆண ࡍࡿࡇ ྥࡀࡺࡗࡃࡾ࡛࠶ࡿࡇ࡜ࡣᚑ᮶ࡢ༳㇟࡟୍⮴ࡋ ࡜࡟㐃࡞ࡿ㺨㺼㺐㺓㺭㺎㺔㺎࡜ࡋ࡚ࡢព⩏ࢆド࡛᫂ࡁࡿ ࡚࠸ࡿࠋࡑࡢ୰࡛ࠊ⤒㐣୰࡟⅖⑕㸦ឤᰁ㸽㸧ࢆే ྍ⬟ᛶࡀ࠶ࡿࠋ Ⓨࡋࡓ౛࡛ࡣ⒗ᚄࡢᛴᛶᣑ኱ࢆㄆࡵࠊࡑࡢ⅖⑕ࡀ ᑠཱྀᚄ኱ື⬦⒗ࡢ⮬↛ணᚋ 1 R ᖺ 㱋 ᛶ ู ṓ ⒗ ᙧ ែ ⌧ ᅾ ࡲ ࡛ࡢ ⒗ ᚄኚ ໬ 㺪㺉㺹㺎㺏㺍㺪㺽 ᮇ 㛫 ഛ ⪃ ึ デ ᫬ ⅖⑕ ᛶ ኱ື ⬦ ⒗ ࠋ ⏨ ᛶ ⭈ ື ⬦ ୗ⣳ 㗽 ⒗ PPЍPP ᖺ ⏨ ᛶ ⭈ ື ⬦ ୗ⣳ 㗽 ⒗ PPЍPP ᖺ ⏨ ᛶ ⭈ ື ⬦ ୗ⣳ 㗽 ⒗ PPЍPP ᖺ ⏨ ᛶ 㐲 ఩ ᘪ 㒊ᄷ ≧ ⒗ PPЍPP ᖺ ⤒ 㐣 ୰ ࡟⅖ ⑕ ⒗ࡢ ᙧ ែ ࠋ ⏨ ᛶ 㐲 ఩ ᘪ 㒊ᄷ ≧ ⒗ PPЍPP ᖺ ⏨ ᛶ ⭈ ື ⬦ ୗᄷ ≧ ⒗ PPЍPP ᖺ 㝈 ᒁ ゎ㞳ࢆ క ࠺ࠋ ⏨ ᛶ 㐲 ఩ ᘪ 㒊⣳ 㗽 ⒗ P P Ѝ P P ⭈ ື ⬦ ୗ⣳ 㗽 ⒗ ᖺ ⏨ ᛶ PPЍPP ᖺᮍ‶ ⏨ ᛶ 㐲 ఩ ᘪ 㒊⣳ 㗽 ⒗ ⭈ ື ⬦ ୗ⣳ 㗽 ⒗ PP ᖺ ᮍ ‶ ⏨ ᛶ PPЍPP ᖺ ᮍ ‶ 㐲 ఩ ᘪ 㒊ᄷ ≧ ⒗ ⭈ ື ⬦ ୗ⣳ 㗽 ⒗ - 211 - 㸦 ᣦ 㸧 ࢸ ࢿ ࢖ ࢩ ࣥ & ࡟ ࡼ ࡿ ⑓ ែ ゎ ᯒ ศᢸ◊✲⪅㸸ᘅỤ㐨᫛ 㸯㸬┠ⓗ ౛ࠊዪᛶ㸰㸯౛㸧ࢆⓎ⑕┤ᚋ࠿ࡽ⤒᫬ⓗ࡟ධ ኱ື⬦⒗ࡣእ⛉ⓗ⑌ᝈ࡜ࡉࢀ࡚࠸ࡿࡀࠊᑠ 㝔㸰㸶᪥ࡲ࡛᥇⾑ࡋࡓࠋ᥇⾑ࡋࡓ⾑Ύࢸࢿ࢖ ཱྀᚄ኱ື⬦⒗࡟እ⛉㐺ᛂࡣ࡞ࡃࠊ↓⑕≧࡛࠶ ࢩࣥ & ࢆ (/,6$ ࢟ࢵࢺ࡟࡚ ᐃࡋࡓࠋ ࡿࡀᨾ࡟₯ᅾⓗ࡞⑕౛ᩘࡣከ࠸࡜ᛮࢃࢀࡿࠋ ᑠᚄ⒗ࡢᝈ⪅ࡣᑗ᮶ࡢᣑ኱㺃◚⿣㺃✺↛Ṛࢆ༴ 㸱㸬⤖ᯝ ᝹ࡋ࡚ࡢᚰ⌮ⓗ㈇ᢸࡶ኱ࡁ࠸ࡀࠊ⌧ᅾ㐍⾜ࢆ 㸯㸧೺ᖖ㸰㸮౛ࡢ⾑Ύࢸࢿ࢖ࢩࣥ & ್ࡣᖹᆒ ᢚ࠼ࡿ἞⒪ἲࡣ࡞࠸ࠋ 㸰㸵㸬㸲㼼䠔䠊䠔㼚㼓㻛㼙㼘䛷䛒䛳䛯䚹㻌 ኱ື⬦⒗ࡢᇶ♏⑓ែࡣ៏ᛶ⅖⑕࡛࠶ࡾࠊ⅖ 䠎䠅ᛴᛶᛴᛶ኱ື⬦ゎ㞳㸦6WDQIRUG% ᆺ㸧㸲㸱 ⑕㒊఩࡟ྲྀࡾ㎸ࡲࢀࡿ )'*3(7 㝧ᛶࡣ኱ື⬦ ౛ࡢⓎ⑕┤ᚋ࡛ࡣࠊ⾑Ύࢸࢿ࢖ࢩࣥ & ್ࡣᖹ ⒗◚⿣ࡢ༴㝤ᅉᏊ࡛࠶ࡿ࡜ࡢሗ࿌ࡀ࠶ࡿࠋࡉ ᆒ㸴㸴㸬㸲㼚㼓㻛㼙㼘䛷䚸䠍㐌㛫ᚋ䛻䛿䠔䠎䠊䠐㼚㼓㻛㼙㼘 ࡽ࡟ᡃࠎࡣࣄࢺ኱ື⬦⒗⤌⧊࠾ࡼࡧ኱ື⬦⒗ 䛸᭱㧗್䜢♧䛧䛯䚹ᚎ䚻䛻పୗ䛧䚸Ⓨ⑕䠎䠔᪥ᚋ ື≀ࣔࢹ࡛ࣝࡣࢸࢿ࢖ࢩࣥ㹁Ⓨ⌧ࡀ㧗್࡛࠶ 䛻䛿䠐䠌䠊䠐㼚㼓㻛㼙㼘䛸ṇᖖ್ෆ䛻䛺䛳䛯䚹㻌 ࡿࡇ࡜ࢆぢ࠸ࡔࡋࡓࠋࢸࢿ࢖ࢩࣥ㹁ࡣ⅖⑕࡛ ୍㐣ᛶ࡟Ⓨ⌧ࡍࡿ⣽⬊እ࣐ࢺࣜࢡࢫࢱࣥࣃࢡ ࡛࠶ࡾࠊ㐺ษ࡞⑓ែࣂ࢖࣐࣮࣮࢜࢝࡟࡞ࡿ࡜ ⪃࠼ࡽࢀࡿࠋ ᮏࣉࣟࢪ࢙ࢡࢺ࡛ࡣࠊᑠᚄ⒗ᝈ⪅ࢆᑐ㇟࡜ ࡋࡓ᳨ウ࡟ຍ࠼ࠊእ⛉ⓗ἞⒪ࡢ᳨ウࢆጞࡵࡿ ᚄ㸲㸬㸳ࢭࣥࢳ࠿ࡽእ⛉ⓗ἞⒪ᑐ㇟࡜࡞ࡿ㸳 ࢭࣥࢳ௨ୖࡢ኱ᚄ⒗ᝈ⪅࡛ࠊ⾑Ύࢸࢿ࢖ࢩࣥ 㹁್ࡢ᥎⛣ࢆ᳨ウࡋࠊ἞⒪๓ᚋࡢኚ໬࡟ࡶ╔ ┠ࡍࡿࠋࡉࡽ࡟ᛴᛶ኱ື⬦ゎ㞳ࢆᑐ↷࡜ࡋ࡚ ࡉࡽ࡟▷ᮇணᚋ࡟ࡘ࠸᳨࡚ウࡋࡓ⤖ᯝࠊṚஸ ኱ື⬦⒗࡜ࡢ㐪࠸࡟ࡶ᳨ウࡍࡿࠋ ⩌㸦㸱౛㸧࡛ࡣ⏕Ꮡ⩌࡟ẚ㍑ࡍࡿ࡜᭷ព࡟㧗 ್ࢆ♧ࡋ࡚࠸ࡓ㸦㹮㸺㸮㸬㸮㸯㸧ࠋ 㸰㸬᪉ἲ TN-C ᑐ㇟࡜ࡋ࡚ࠊ೺ᖖ౛㸰㸮౛⏨ᛶ㸯㸲౛ࠊዪ 300 ᛶ㸴౛ࠊᚄ㸲㸬㸳ࢭࣥࢳ࠿ࡽእ⛉ⓗ἞⒪ᑐ㇟ 250 200 ࡜࡞ࡿ㸳ࢭࣥࢳ௨ୖࡢ኱ᚄ⒗ᝈ⪅㸦⬚㒊኱ື 150 ⬦⒗㸸DEGRPLQDODRUWLFDQHXU\VP$$$㸧㸰㸲 ྡ㸦ᖺ㱋㸴㸳㹼㸶㸷ṓࠊᖹᆒ㸵㸶ṓࠊ⏨ᛶ㸰 50 㸰౛ࠊዪᛶ㸰౛㸧࠾ࡼࡧᑠᚄ⒗ᝈ⪅㸯㸮౛ࢆ 0 Survival ᳨ウࡋࡓࠋࡉࡽ࡟ᛴᛶ኱ື⬦ゎ㞳㸦ゎ㞳ᛶ኱ ື⬦⒗㸧㸲㸱౛㸦ᖹᆒᖺ㱋㸵㸮ṓࠊ⏨ᛶ㸰㸰 Death 㸱㸧 እ⛉ⓗ἞⒪ᑐ㇟࡜࡞ࡿ㸳ࢭࣥࢳ௨ୖࡢ኱ - TN-C 100 212 - ᚄ⒗ᝈ⪅㸦$$$㸧㸰㸲ྡࡢ⾑Ύࢸࢿ࢖ࢩࣥ & ࡿࡀࠊ௒ᅇࡢࢹ࣮ࢱ࠿ࡽࡣࢸࢿ࢖ࢩࣥ & ࡀ᭱ ್ࡣࠊ㸯㸴㸬㸴㹼㸯㸰㸰㸬㸰㼚㼓㻛㼙㼘䠄ᖹᆒ䠐䠍䠊㐺࡞ࣂ࢖࣐࣮࣮࡛࢜࢝࠶ࡿ࠿࡟ࡘ࠸࡚ࡣ⤖ㄽ 䠓䠅䛷䛒䛳䛯䚹䛧䛛䛧ṇᖖ್௨ୖ䜢࿊䛧䛯⑕౛ᩘ ࡀᚓࡽࢀ࡚ࡣ࠸࡞࠸ࠋࡉࡽ࡞ࡿ⑕౛ࡢ⵳✚࡟ 䛿䠑౛䛷䛒䜚䚸⒗ᚄ䛸䛾㛵㐃䛿ㄆ䜑䜙䜜䛺䛛䛳 ࡼࡿ᳨ウࡀᚅࡓࢀࡿࠋ 䛯䚹㻌㸳㸬⤖ㄽ 䠐䠅䠐㼏㼙 ⛬ᗘ䛾ᑠᚄ⒗ᝈ⪅㸦$$$㸧㸯㸮౛࡛ࡣ ᛴᛶ኱ື⬦ゎ㞳⑕౛࡛ࡣࢸࢿ࢖ࢩࣥ & ࡣ᪂ ࢚ࣥࢺ࣮ࣜࡢࡳ࡛᫬㛫ࡢ㛵ಀ࡛ ᐃ࡛ࡁ࡞࠿ ࡗࡓࠋ ࡋ࠸⅖⑕ࣂ࢖࣐࣮࣮࢜࢝࡜ࡋ࡚㔜⑕ᗘ࣭ணᚋ ุᐃ࡟᭷ຠ࡛࠶ࡿࡇ࡜ࡀุ᫂ࡋࡓࠋ⬚㒊ື⬦ 㸲㸬⪃ᐹ ⒗$$$࡟㛵ࡋ࡚ࡣࠊ௒ᚋࡢࡉࡽ࡞ࡿ᳨ウࡀᚲ せ࡛࠶ࢁ࠺ࠋ ኱ື⬦⒗࡟ࡣࠊᛴᛶ࡟Ⓨ⑕ࡍࡿᛴᛶゎ㞳ື ⬦⒗ࡸ⦆ࡸ࠿࡟ᣑ኱ࡋࠊᛴ⃭࡟◚⿣㺃✺↛Ṛࢆ ࿊ࡍࡿ┿ᛶື⬦⒗⬚㒊࣭⭡㒊࡞࡝ࡀ࠶ࡾࠊ 㸴㸬◊✲Ⓨ⾲ཬࡧ≉チ ࡑࡢ⮫ᗋࡣከᙬ࡛ࠊ⮫ᗋデ᩿࡟ⱞ៖ࡋ࡚࠸ࡿࠋ 1R]DWR76DWR$+LURH0HWDO6HUXP ≉࡟┿ᛶື⬦⒗⬚㒊࣭⭡㒊ࡣഅ↛ࠊ೺ᗣデ 7HQDVFLQ& /HYHOV 0LJKW EH D 1RYHO ᩿࡛Ⓨぢࡉࢀࡿ⑕౛ࡀከ࠸࠸ࠋࡉࡽ࡟἞⒪㸦ᡭ %LRPDUNHU IRU 3UHGLFWLQJ 6KRUWWHUP ⾡ࡸ 67(17 ἞⒪㸧ࡢ᫬ᮇỴᐃ࡟ࡣࠊ⒗ࡢᙧែ࣭ 3URJQRVLVRI7\SH%$FXWH$RUWLF'LVVHFWLRQ ᚄࡸ⮫ᗋ⑕≧࡞࡝」ᩘࡢᅉᏊࡀ㛵୚ࡋ࡚࠾ࡾ $+$1RYHPEHU2UODQG86$ ᅔ㞴ࢆᴟࡵ࡚࠸ࡿࠋ┿ᛶື⬦⒗⬚㒊࣭⭡㒊 ≉チ ࡢᇶ♏⑓ែࡣ៏ᛶ⅖⑕࡜⪃࠼ࡽࢀ࡚࠸ࡿࡇ࡜ ࡞ࡋ ࡟ὀ┠ࡋࠊᮏ◊✲࡛ࡣࠊ⅖⑕࡟㛵ࢃࡿ᪂ࡋ࠸ ⾑୰ࣂ࢖࣐࣮࣮࢜࢝ࢆ᥈⣴ࡍࡿࡇ࡜ࢆ┠ⓗ࡜ ࡋࡓࠋ ⅖⑕ࡸ⤌⧊ಟ᚟ࣜࢹࣜࣥࢢ࡟ಀࢃࡿ⣽⬊እ ࣐ࢺࣜࢵࢡࢫ⺮ⓑࡢ୍ࡘࢸࢿ࢖ࢩࣥ & ࡣ 䚸ṇ ᖖᡂయ࡛ࡣⓎ⌧ࡋ࡞࠸ࡀࠊᚰ➽⅖ࠊᚰ➽᱾ሰ ࡞࡝࡛⤌⧊㞀ᐖ࣭⅖⑕࡟కࡗ୍࡚㐣ᛶ࡟άື ᛶ⑓ኚ㒊఩࡟㝈ᒁࡋ࡚Ⓨ⌧ࡍࡿࡇ࡜ࡀุ᫂ࡋ ࡚࠸ࡿࠋඛࡎࠊᛴᛶᛴᛶ኱ື⬦ゎ㞳⑕౛᳨࡛ ウࡋࡓ⤖ᯝࠊ⾑Ύࢸࢿ࢖ࢩࣥ & ್ࡣⴭ᫂࡟ቑ ຍࡋ࡚࠾ࡾࠊࡉࡽ࡟▷ᮇணᚋࡢホ౯࡟ࡶᛂ⏝ ࡛ࡁࡿࡇ࡜ࡀุ᫂ࡋࡓࠋḟ࡟⬚㒊ື⬦⒗$$$ ࡛ 67(17 ἞⒪ࡢ㐺ᛂࡢ࠶ࡿ⑕౛࡛ࡣࠊ୍㒊࡟ ⾑Ύࢸࢿ࢖ࢩࣥ & ್ࡣቑຍࡋ࡚࠸ࡓࡀࠊ㢖ᗘ ࡣᚲࡎࡋࡶከࡃࡣ࡞࠸ࠋࡇࡢ⤖ᯝ࠿ࡽࠊ⬚㒊 ື⬦⒗$$$ࡢ⑓ែࡣ៏ᛶ⅖⑕࡜ゝࢃࢀ࡚࠸ - 213 - 㸦 ᣦ 㸧㐠ື⒪ἲ࡟㛵ࡍࡿ⮫ᗋ◊✲ ศᢸ◊✲⪅㸸㔝⏣ගᙪ 㸯㸬┠ ⓗ ௳࡛࠶ࡗࡓࠋ ࠕ⢾ᒀ⑓➼ࡢ⏕ά⩦័⑓ᑐ⟇ࡢ᥎㐍࡟㛵ࡍࡿ᳨ ⑓ᆺูᝈ⪅ᩘࡣḟࡢ⾲ࡢࡼ࠺࡛࠶ࡗࡓࠋ ウ఍ࠖ࡟࠾࠸࡚ࠊᣐⅬᶵ㛵ࡀ⮫ᗋࢹ࣮ࢱࢆ཰㞟࣭ ⑓ᆺ ⏨ᛶ ዪᛶ ศᯒࡍࡿࡇ࡜ࡢ㔜せᛶࡀᣦ᦬ࡉࢀࡓࠋᮏ◊✲ࡣࠊ ᆺ⢾ᒀ⑓ ࡇࢀࢆල⌧໬ࡋࠊࡑࡢά⏝ࡢ୍⎔࡜ࡋ࡚ࠊ⢾ᒀ⑓ ᆺ⢾ᒀ⑓ ᝈ⪅࡟࠾ࡅࡿᚰ⾑⟶⑌ᝈࡢࣜࢫࢡᅉᏊࢆྠᐃࡋࠊ ⮅እศἪ⑌ᝈ ᑓ㛛⑓㝔࠿ࡽ୍⯡⑓㝔ࠊデ⒪ᡤ࡟ᩜ⾝࡛ࡁࡿண㜵 ⫢⑌ᝈ ᑐ⟇ࢆᥦ♧ࡍࡿࡇ࡜ࡀ┠ⓗ࡛࠶ࡿࠋศᢸ◊✲ㄢ㢟 ⸆๣ᛶ ࡜ࡋ࡚ࠊᅜ❧ᅜ㝿་⒪ࢭࣥࢱ࣮ᡞᒣ⑓㝔࡟࠾ࡅࡿ ዷፎ⢾ᒀ⑓ 㸫 ᝈ⪅᝟ሗⓏ㘓ࢆᐇ᪋ࡋࠊ⥲ᣓࡍࡿࠋ ࣑ࢺࢥࣥࢻࣜ 㸰㸬᪉ ἲ ࢔㑇ఏᏊ␗ᖖ ᅜ❧ᅜ㝿་⒪ࢭࣥࢱ࣮ᡞᒣ⑓㝔࡟࠾࠸࡚ࠊ⢾ᒀ ࡑࡢ௚ ⑓᝟ሗࢭࣥࢱ࣮஦ᴗ࡜ࡋ࡚㐍⾜୰࡛࠶ࡿ⢾ᒀ⑓ᝈ ྜィ ⪅ࢹ࣮ࢱ࣮࣋ࢫ࡟ᝈ⪅᝟ሗࢆⓏ㘓ࡋࠊࡑࢀࢆ⏝࠸ ࡚ᶓ᩿◊✲࠾ࡼࡧᚋࢁྥࡁࢥ࣮࣍ࢺ◊✲ࢆ⾜࠺ࠋ ලయⓗ࡟ࡣࠊ➲᭶⌜࡟࠾࠸࡚సᡂࡉࢀࡓ (;&(/ ࣐ࢡࣟࣉࣟࢢ࣒ࣛࢆ⏝࠸࡚ࠊᝈ⪅ᇶᮏ᝟ሗ㸦ᝈ⪅ ࡢ⏕ᖺ᭶ࠊ⑓ᆺࠊ᪤ Ṕ࡞࡝ࢆྵࡴ㸧ࠊᝈ⪅ᣦᑟ᝟ ⌧ᅾࡇࢀࡽ࡟ࡘ࠸࡚ࢹ࣮ࢱࡢࢡ࣮ࣜࢽࣥࢢ➼ࢆ⾜ ࡗ࡚࠸ࡿࠋ ḟ࡟ࠊ ᖺ ᭶ᮎࡲ࡛ࡢᝈ⪅἞⒪᝟ሗ࡟ࡘ࠸࡚ ࡢ㞟ィࢆ⾜ࡗࡓࠋ ሗ㸦㣗஦⒪ἲࡢᣦᑟෆᐜࡸࠊႚ↮࡞࡝⏕ά⩦័࡟ 㛵ࡍࡿ᝟ሗࢆྵࡴ㸧 ࠊᝈ⪅἞⒪᝟ሗ㸦ᢞ⸆ࠊ᳨ᰝ᝟ ሗ࡞࡝ࢆྵࡴ㸧ࢆⓏ㘓ࡋ࡚࠸ࡿࠋࢹ࣮ࢱ࣮࣋ࢫࡢ Ⓩ㘓㡯┠ࡀヲ⣽࡟ࢃࡓࡿࡓࡵࠊᝈ⪅Ⓩ㘓ࡣձ ᖺ ᭶࠿ࡽ ᖺ ᭶ࡲ࡛ࡢධ㝔ᝈ⪅ࢧ࣐࣮ࣜ ࢆ฼⏝ࡋ࡚࡛ࡁࡿࡔࡅヲ⣽࡞᝟ሗࡢࡑࢁࡗ࡚࠸ࡿ ⑕౛ࢆࡲࡎⓏ㘓ղእ᮶㏻㝔ᝈ⪅࡛ձ࡟࠾࠸࡚Ⓩ㘓 ࡋࡓࡶࡢࢆ㝖ࡁࠊእ᮶࢝ࣝࢸ࠿ࡽᚓࡽࢀࡿ᝟ሗ ࢆⓏ㘓 ࡢ㡰࡛㐍ࡵࡓࠋ ᭶ᮎࡲ࡛ࡢᝈ⪅ࢹ࣮ࢱ ࢆ⤫ྜࡋࠊ&69 ᙧᘧࡢࢸ࢟ࢫࢺࣇ࢓࢖ࣝ࡜ࡋࡓࡢ ࡕ࡟ࠊ6366 ࢆ⏝࠸࡚᪋タෆ㞟ィࢆ⾜ࡗࡓࠋ 㸱㸬⤖ ᯝ ᖺ ᭶ ᪥⌧ᅾ࡛ࠊ⏨ᛶ ྡ ዪᛶ ྡࡀⓏ㘓ࡉࢀࡓࠋࡲࡓᝈ⪅ᣦᑟ᝟ሗࡢධຊ௳ᩘࡣ 1 ዪᛶ ᖹᆒ್ 1 ᖹᆒ್ %0, 6%3 '%3 ⾑⢾್ +E$F 7&KRO +'/&KRO /'/&KRO 7* &UH Ț*73 㸦6%3㸸཰⦰ᮇ⾑ᅽ '%3㸸ᣑᙇᮇ⾑ᅽ㸧 ᘏ࡭ ௳ࠊ ᝈ⪅἞⒪᝟ሗࡢධຊ௳ᩘࡣᘏ࡭ - ⏨ᛶ 214 - ࡞࠾ࡇࡇ࡛ࡣࠊᝈ⪅ࡑࢀࡒࢀࡢᝈ⪅἞⒪᝟ሗ᭱⤊ ࡋࡓࠋࡇࡢࡓࡵࠊධຊࡉࢀࡓࢹ࣮ࢱࡣࠊ⾑⢾ࢥࣥ ྲྀᚓ᪥࡟࠾࠸࡚ࠊᑐᛂࡍࡿ㡯┠ࡢධຊࡀ࠶ࡿሙྜ ࢺ࣮ࣟࣝࡢᝏ࠸≧ែ࡛ࡢࡶࡢ࡜࡞ࡗ࡚࠸ࡿࠋ⤖ᯝ ࡟㞟ィᑐ㇟࡜࡞ࡗ࡚࠸ࡿࠋ౛࠼ࡤ᭱⤊ࢹ࣮ࢱ᥇ྲྀ ࡟♧ࡍ࡜࠾ࡾࠊ+E$F ್ࡢศᕸࡣṇつ᭤⥺ࢆ࡜ࡽ ᪥ࡢ᳨ᰝෆᐜࡀᚰ㟁ᅗࡔࡅ࡛࠶ࡿ࡜࠿ࠊฎ᪉࡜デ ࡎࠊ್ࡢ㧗࠸ഃ࡟ᗈࡃศᕸࡍࡿᙧ࡜࡞ࡗ࡚࠸ࡿࠋ ᐹࡔࡅ᳨࡛ᰝࡣ⾜ࢃࢀ࡚࠸࡞࠿ࡗࡓሙྜ࡟ࡣ᳨ᰝ 㔜⑕࡞ᝈ⪅ࡢ࡯࠺ࡀⓏ㘓ࡉࢀࡸࡍ࠸ࡢ࡛ࡣ࡞࠸࠿ ್ࡢ㞟ィࡢᑐ㇟࠿ࡽእࢀࡿࠋࡲࡓࠊ᭱⤊ࢹ࣮ࢱ᥇ ࡜࠸࠺ၥ㢟ࡣ➨୍ᅇ⌜఍㆟࡛ࡍ࡛࡟ᣦ᦬ࡉࢀ࡚࠾ ྲྀ᪥࡟࠾࠸࡚ࠊ+E$F ࡛࡞ࡃࢢࣜࢥ࢔ࣝࣈ࣑ࣥࡀ ࡾࠊࡑࡢ᫬Ⅼ࡛ࡣእ᮶㏻㝔ࢹ࣮ࢱ࠿ࡽࡢⓏ㘓ࡀࡲ ᐃࡉࢀ࡚࠸ࡓࡢࡣ⏨ᛶ ྡࠊዪᛶ ྡ࡛࠶ࡗ ࡔ࡯࡜ࢇ࡝⾜ࢃࢀ࡚࠸࡞࠿ࡗࡓࡓࡵࠊ+E$F ࡢᖹ ࡓࠋࡲࡓࠊ+E$F ࡟ࡘ࠸࡚ࡣዪᛶ࡟࠾࠸࡚ࡣࡎࢀ ᆒ್ࡀ 㸣ࢆ㉸࠼ࡿ≧ἣ࡛࠶ࡗࡓࠋධ㝔ᝈ⪅ࡢ㏥ ್㸦 ࢆ㉸࠼ࡿධຊ࢚࣮ࣛ㸧 ௳ࢆ㝖እࡋࡓࠋ 㝔ᚋࢹ࣮ࢱࡢධຊࡸࠊእ᮶㏻㝔ࡢࡳࡢᝈ⪅ࢹ࣮ࢱ ḟ࡟ +E$F ್ࡢศᕸࢆ⏨ዪู࡟♧ࡍࠋ ධຊࡢ᥎㐍࡟ࡼࡾࠊࡇࡢࡼ࠺࡞ࢹ࣮ࢱࡢ೫ࡾࡀᨵ ၿࡍࡿࡶࡢ࡜ᮇᚅࡉࢀࡿࠋ ࡑࢀࡒࢀࡢ⑓㝔ࡢࡶࡘ≉Ⰽ࡟ࡼࡗ࡚ࠊᝈ⪅ࡢᛶ ㉁ࡀ೫ࡿࡢ࡛ࡣ࡞࠸࠿࡜࠸࠺ၥ㢟ࡶᣦ᦬ࡉࢀ࡚࠸ ࡿࠋⓏ㘓ᝈ⪅ࡢ⏨ዪẚࡣ⣙ 㸸 ࡛࠶ࡗࡓࡀࠊᅜ❧ ࡀࢇࢭࣥࢱ࣮࡜ࡢඹྠ◊✲㸦ὠ㔠⌜㸧࡟࠾ࡅࡿ኱ つᶍఫẸࢥ࣮࣍ࢺ◊✲࡟࠾࠸࡚ࠊᶓᡭ࣭஧ᡞ࣭బ ஂ࣭Ἀ⦖┴▼ᕝ࡟࠾ࡅࡿ⮬ᕫ⏦࿌⢾ᒀ⑓ࡢⓎ⑕⋡ ࡢ⏨ዪẚࡣ࠸ࡎࢀࡢᆅᇦ࡟࠾࠸࡚ࡶ⏨ᛶࡀዪᛶࡢ ⣙ ಸ࡛࠶ࡗࡓࡇ࡜ࢆ⪃࠼ࡿ࡜㸯㸧ࠊᑡ࡞ࡃ࡜ࡶ⏨ ዪẚ⋡࡟ࡘ࠸࡚ࡣࠊ୍⯡ⓗ⑓㝔࡟㏻㝔ࡍࡿ⢾ᒀ⑓ ᝈ⪅ࢆ௦⾲࡛ࡁࡿྍ⬟ᛶࢆ♧၀ࡋ࡚࠸ࡿࠋࡇࡢⅬ ࡣࣅࢪࢿࢫ⾤❧ᆅࡢ୸ࡢෆ⑓㝔ࡸ⫋ᇦ⑓㝔࡛࠶ࡿ -5 ᮾி⥲ྜ⑓㝔࡜ࡢ㐪࠸࡛࠶ࡿ㸦ࡇࢀࡽ࡛ࡣ⏨ᛶ ࡢⓏ㘓ࡀᅽಽⓗ࡟ከ࠸㸧ࠋ%0, ࡟ࡘ࠸࡚ࡣࠊ๓㏙ࡢ ኱つᶍఫẸࢥ࣮࣍ࢺ࡟࠾࠸࡚⢾ᒀ⑓ࢆⓎ⑕ࡋࡓ⩌ ࡣ 㸫㸦ᮏᕞࡢࡳ㸧࡛࠶ࡿࡀࠊࡑࡢᖺ㱋ࡀ ṓ࠿ࡽ ṓ࡛ࡢ್࡛࠶ࡿ㸯㸧ࠋᙜ㝔࡛Ⓩ㘓ࡉࢀ ࡓᝈ⪅ࡢ㸦⢾ᒀ⑓ᝈ⪅࡜ࡋ࡚ࡢ㸧ึデ᫬ᖺ㱋ࡣ⏨ ዪ࡜ࡶ 㸫 ṓ࡟ࣆ࣮ࢡࡀ࠶ࡿ㸦ࢹ࣮ࢱ┬␎㸧 ࠋ ᴫࡋ࡚ᙜ㝔ཷデᝈ⪅ࡢᖺ㱋ࡣࠊ%0, ࡀపୗࡋ࡚ࡃ 㸲㸬⪃ ᐹ ࡿᖺ௦࡛࠶ࡿࡇ࡜ࢆ⪃࠼ࡿ࡜㸰㸧ࠊ⫧‶ᗘ࡟࠾࠸࡚ ᙜ㝔ࡢᝈ⪅Ⓩ㘓ࡣࠊᝈ⪅἞⒪᝟ሗ࡟ࡘ࠸࡚⚄⤒Ꮫ ࡶ୍⯡ⓗ࡞㏻㝔ᝈ⪅࡜኱ࡁࡃࡣ␗࡞ࡽ࡞࠸ࡢ࡛ࡣ ⓗᡤぢࠊᒀ୰࢔ࣝࣈ࣑ࣥᐃ㔞ࠊᚰ㟁ᅗᡤぢ➼ࠊእ ࡞࠸࠿࡜ᮇᚅࡉࢀࡿࠋ ᮶デ⒪ศࡢࢹ࣮ࢱ࡛ࡣᚓࡽࢀ࡟ࡃ࠸㡯┠࡟ࡘ࠸࡚ 㸳㸬⤖ㄽ ࡶᴟຊධຊࢆ⾜࠺ࡓࡵࠊධ㝔ᝈ⪅ࢆඃඛⓗ࡟Ⓩ㘓 ᅜ❧ᅜ㝿་⒪ࢭࣥࢱ࣮ᡞᒣ⑓㝔࡟࠾ࡅࡿ ᖺ - 215 - ᗘᝈ⪅Ⓩ㘓ࡣධ㝔ᝈ⪅ࢹ࣮ࢱࡀ୺య࡛࠶ࡗࡓࠋ௒ ᚋࡉࡽ࡟እ᮶㏻㝔ᝈ⪅ࢹ࣮ࢱࡢ⥙⨶ⓗⓏ㘓ࢆ᥎㐍 ࡍࡿᚲせࡀ࠶ࡿࠋ 㸴㸬◊✲ᡂᯝࡢබ⾲ ࡞ࡋ 㸵㸬ཧ⪃ᩥ⊩ 㸯㸧:DNL . ࡽ$OFRKROFRQVXPSWLRQDQGRWKHU ULVN IDFWRUV IRU VHOIUHSRUWHG GLDEHWHV DPRQJ PLGGOHDJHG -DSDQHVH D SRSXODWLRQEDVHG SURVSHFWLYH VWXG\ LQ WKH -3+&VWXG\FRKRUW,'LDEHWLF0HGLFLQH 㸰㸧0DWVXVKLWD < ࡽ㸸2YHUZHLJKWDQGREHVLW\ WUHQGV DPRQJ -DSDQHVH DGXOWV D \HDU IROORZXSRIWKH-3+&VWXG\,QW-2EHVLW\ - 216 - 㸦21 ᣦ 117㸧CT ࡟ࡼࡿ኱ື⬦⒗ࡢᙧែศᯒ ศᢸ◊✲⪅㸸ⶈᑿ㔠༤ 㸯㸬┠ⓗ 36.4mm ࡛࠶ࡗࡓࠋ᭱⤊ࡢ CT ࡛ࡢື⬦⒗ᚄࡣ 36 ኱ື⬦⒗ࡣ኱ື⬦ቨࡢᒁᡤⓗ࡞⬤ᙅ໬࡜ᚄࡢᣑ 㹼68mm ࡛ࠊᖹᆒ 47.1mm ࡛࠶ࡗࡓࠋື⬦⒗ᚄࡢ ኱ࡀ↓⑕≧ࡢࡲࡲ㐍⾜ࡋࠊࡘ࠸࡟ࡣ◚⿣࣭✺↛Ṛ ኚ໬ࡣ 1mm ࠿ࡽ 29mm ࡲ࡛ࠊᗈ࠸⠊ᅖ࡟ศᕸࡋ ࡟⮳ࡿཎᅉ୙᫂ࡢ⑌ᝈ࡛࠶ࡿࠋ἞⒪ἲࡣࠊ㛤⬚࣭ ࡚࠸ࡓࠋື⬦⒗ᚄࡢኚ໬ࡢᖹᆒࡣ 10.4mm ࡛࠶ࡗ 㛤⭡࡟ࡼࡿேᕤ⾑⟶⨨᥮⾡ᡈ࠸ࡣࢫࢸࣥࢺࢢࣛࣇ ࡓࠋ⤒㐣ほᐹᮇ㛫୰࡟ 10 ౛୰ 9 ౛࡛ 2mm ௨ୖ ࢺෆᤄ⾡࡛࠶ࡿࡀࠊᝈ⪅ᩘࠊᡭ⾡௳ᩘࠊṚஸᩘ࡜ ࡢቑ኱ࡀぢࡽࢀࡓࠋ ᚄࡢኚ໬ࢆほᐹᮇ㛫࡛๭ࡿ࡜ࠊ ࡶቑຍࡢ୍㏵ࢆࡓ࡝ࡗ࡚࠾ࡾࠊ἞⒪ࢥࢫࢺࡶᛴቑ ື⬦⒗ᚄࡢᖺᖹᆒࡢቑ኱㏿ᗘࡣ 2.7mm ࡛࠶ࡗࡓࠋ ࡋ࡚࠸ࡿࠋ୍᪉ࠊ◚⿣ࡢ༴㝤ᗘࡢప࠸ᑠᚄ⒗ࡶ☜ 㸲㸬⪃ᐹ ᐇ࡟㐍⾜ࡋࠊ୍ᐃࡢ๭ྜ࡛◚⿣࣭✺↛Ṛࢆ᮶ࡍࡇ ᑠᚄ኱ື⬦⒗ࡣ᪥ᖖデ⒪࡟࠾࠸࡚㢖⦾࡟㐼㐝ࡍ ࡜ࡀ᫂ࡽ࠿࡜࡞ࡗ࡚࠸ࡿࡀࠊᑠᚄ⒗ࡢ⮬↛⤒㐣࡟ ࡿࡁࢃࡵ࡚࠶ࡾࡩࢀࡓ⑌ᝈ࡛࠶ࡿࠋ ࡋ࠿ࡋ࡞ࡀࡽࠊ 㛵ࡋ࡚ᮍࡔ༑ศ࡞᳨ウࡣ࡞ࡉࢀ࡚࠸࡞࠸ࠋᮏ◊✲ ᑠᚄ኱ື⬦⒗ࡢ⤒㐣ほᐹࢆ┠ⓗ࡜ࡋ࡚ࠊ⤒᫬ⓗ࡟ ࡣࠊᑠᚄ኱ື⬦⒗ࢆ⏕ά⩦័⑓ࡢᯟ⤌ࡳ࡛ᤊ࠼┤ CT ᳨ᰝࢆ⾜࠺ࡇ࡜ࡣᑡ࡞ࡃࠊࡑࡢ⮬↛Ṕࡣ௨እ ࡍࡇ࡜࡟ࡼࡾ᪂ࡓ࡞⑓ែデ᩿࣭἞⒪ἲࢆ᳨ウࡋࠊ ࡟▱ࡽࢀ࡚࠸࡞࠸ࠋᮏ◊✲࡛ࡣࠊᅜ❧ᅜ㝿་⒪ࢭ ᝈ⪅ࡢᏳᚰࠊ་⒪㈝๐ῶ࡬㈉⊩ࡍࡿࡇ࡜ࢆ┠ⓗ࡜ ࣥࢱ࣮࡟࠾࠸࡚ 6 ᖺ㛫࡟ CT ࡟࡚デ᩿ࡉࢀࡓᑠᚄ ࡋ࡚࠸ࡿࡀࠊᮏศᢸ◊✲࡛ࡣ◊✲඲యࡢᇶᮏⓗ஦ ኱ື⬦⒗ࡢ⤒᫬ⓗኚ໬ࢆ᳨ウࡋࡓࠋほᐹᮇ㛫୰࡟ 㡯࡛࠶ࡿ኱ື⬦⒗ᙧែࡢ CT ゎᯒࢆ┠ⓗ࡜ࡋ᳨࡚ 10 ౛୰ 9 ౛࡛ 2mm ௨ୖࡢቑ኱ࡀぢࡽࢀࠊᑠᚄ኱ ウࢆ⾜ࡗࡓࠋ ື⬦⒗ࡀ᫬㛫࡜ඹ࡟ቑ኱ࡍࡿ༴㝤࡞⑓ែ࡛࠶ࡿࡇ 㸰㸬᪉ἲ ࡜ࡀ᫂ࡽ࠿࡜࡞ࡗࡓࠋቑ኱㏿ᗘࡣᖺᖹᆒ 2.7mm 2004 ᖺ 1 ᭶࠿ࡽ 2010 ᖺ㸯᭶ࡲ࡛ࡢ 6 ᖺ㛫࡟ᅜ ࡛࠶ࡗࡓࡀࠊᑐ㇟࡜ࡋࡓᝈ⪅ࡢᖹᆒᖺ㱋ࡣ 72.5 ❧ᅜ㝿་⒪ࢭࣥࢱ࣮࡟࠾࠸࡚ CT ࡟࡚⭡㒊኱ື⬦ ṓ࡜㧗㱋࡛ࡣ࠶ࡿࡀࠊ᪥ᮏேࡢᖹᆒᑑ࿨ࢆ⪃៖ࡍ ⒗ࡀㄆࡵࡽࢀࠊᶓ᩿ീ࡛ࡢ᭱኱እᚄࡀ 30㹼40mm ࡿ࡜ࠊࡇࡢ㏿ᗘࡣỴࡋ࡚㐜࠸ࡶࡢ࡛ࡣ࡞࠸࡜ᛮࢃ ࡛ࠊ1 ᖺ௨ୖࡢ⤒㐣ࢆ㏣࠼ࡓࡶࡢࢆᑐ㇟࡜ࡋࡓࠋ ࢀࡿࠋ௒ᚋࠊື⬦⒗ࡢቑ኱㏿ᗘࡀ୍ᐃ࡞ࡢ࠿ᡈ࠸ ィ ࡣ⏬ീほᐹ⿦⨨ୖ࡛⾜࠸ࠊ᭱኱እᚄࢆィ ࡋ ࡣ᩿⥆ⓗ࡞ࡢ࠿ࠊቑ኱㏿ᗘࡢ㏿࠸⑕౛࡛ࡣ࡝ࡢ⛬ ࡓࠋᮇ㛫୰ࡢึᅇ࡜⤒㐣ほᐹ࡜ࡋ࡚⾜ࢃࢀࡓ᭱⤊ ᗘࡢᮇ㛫࡛ほᐹࡍࡿࡢࡀ㐺ᙜ࡞ࡢ࠿ࠊ࡞࡝ࡢ᳨ウ ࡢ CT ᳨ᰝ࡟࠾࠸࡚ィ ࢆ⾜࠸ࠊ⤒᫬ⓗኚ໬ࢆ᳨ ࡀᚲせ࡜ᛮࢃࢀࡿࠋ ウࡋࡓࠋ 㸳㸬⤖ㄽ 㸱㸬⤖ᯝ㸦⾲㸧 ᑠᚄ኱ື⬦⒗ࡢ CT ࡟ࡼࡿ⤒㐣ほᐹࡢ⤖ᯝࢆ᳨ ᑐ㇟࡜ࡋ࡚ヱᙜࡋࡓ⑕౛ࡣ 10 ౛࡛ࠊ ⏨ᛶ 8 ౛ࠊ ウࡋࡓࠋࡑࡢ⤖ᯝࠊᑠᚄ኱ື⬦⒗ࡀᖺᖹᆒ 2.8mm ዪᛶ 2 ౛࡛࠶ࡗࡓࠋᖺ㱋ࡣ 57㹼86 ṓࠊᖹᆒ 72.5 ࡢ㏿ᗘ࡛ቑ኱ࡋ࡚࠾ࡾࠊᑠᚄ኱ື⬦⒗ࡀ᫬㛫࡜ඹ ṓ࡛࠶ࡗࡓࠋ⤒㐣ほᐹᮇ㛫ࡣ 425 ᪥㹼2045 ᪥ࠊ ࡟ቑ኱ࡍࡿ༴㝤࡞⑓ែ࡛࠶ࡿࡇ࡜ࡀ᫂ࡽ࠿࡜࡞ࡗ ᖹᆒ 1391.7 ᪥࡛࠶ࡗࡓࠋほᐹࡉࢀࡓື⬦⒗ࡣࡍ ࡓࠋ ࡭࡚⭈ୗ㒊኱ື⬦⒗࡛ࠊࡋ࠿ࡶ⣳㗽ᆺື⬦⒗࡛࠶ 㸴㸬◊✲Ⓨ⾲࠾ࡼࡧ≉チ ࡗࡓࠋึᅇࡢື⬦⒗ᚄࡣ 30㹼40 mm ࡛ࠊᖹᆒ ࡞ࡋࠋ - 217 - ⾲ ⑕ ᖺ ᭱⤊ᅇ ኱ᚄ ᭱኱ᚄ 䠄㼙㼙䠅㻌䠄㼙㼙䠅㻌 ᛶ ౛ 㱋㻌 ึᅇ᭱ 㒊఩㻌 ኱䛝䛥ほᐹ 䛾ኚ ᮇ㛫 ໬ 䠄᪥䠅㻌䠄㼙㼙䠅㻌㻝㻡㻢㻝㻌㻣㻌㻞㻜㻠㻡㻌㻞㻞㻌㻤㻤㻝㻌㻤㻌㻠㻞㻡㻌㻡㻌㻥㻥㻠㻌㻡㻌㻝㻣㻞㻤㻌㻠㻌㻝㻥㻟㻥㻌㻟㻌㻢㻣㻜㻌㻝㻌㻝㻤㻢㻥㻌㻞㻜㻌㻝㻤㻜㻡㻌㻞㻥㻌 ᙧ≧㻌 ู㻌㻺㼛㻚㻌 ⤒㐣 ⣳㗽㻝㻌㻣㻢㻌㻌 ⏨㻌㻟㻝㽢㻟㻠㻌㻠㻝㽢㻟㻤㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻞㻌㻤㻢㻌㻌 ⏨㻌㻟㻞㽢㻟㻣㻌㻠㻡㽢㻡㻥㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻟㻌㻣㻝㻌㻌 ⏨㻌㻟㻥㽢㻟㻥㻌㻠㻣㽢㻠㻣㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻠㻌㻢㻠㻌㻌 ⏨㻌㻟㻥㽢㻠㻜㻌㻠㻡㽢㻠㻟㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻡㻌㻣㻤㻌㻌 ⏨㻌㻟㻝㽢㻟㻢㻌㻠㻝㽢㻠㻜㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻢㻌㻡㻣㻌㻌 ⏨㻌㻟㻣㽢㻟㻥㻌㻠㻞㽢㻠㻟㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻣㻌㻣㻠㻌㻌 ⏨㻌㻟㻣㽢㻟㻤㻌㻠㻜㽢㻠㻝㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻤㻌㻢㻤㻌㻌 ⏨㻌㻟㻡㽢㻟㻡㻌㻟㻢㽢㻟㻢㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻥㻌㻤㻜㻌㻌 ዪ㻌㻟㻜㽢㻟㻜㻌㻡㻜㽢㻠㻞㻌 ⭈ୗ㒊㻌 ᆺ㻌 ⣳㗽㻝㻜㻌㻣㻝㻌㻌 ዪ㻌㻟㻥㽢㻟㻢㻌㻢㻤㽢㻢㻝㻌 ⭈ୗ㒊㻌 ᆺ㻌 - 218 - 㸦21 ᣦ 117㸧FDG-PET ࡟ࡼࡿ⑓ែデ᩿ ศᢸ◊✲⪅㸸❑⏣࿴㞝 ᖏࡢ࡯࠺ࡀ᫂☜࡞⏬ീ࡛࠶ࡗࡓࠋ 㸯㸬┠ ⓗ ⢾௦ㅰ⸆๣ࠊ) ᶆ㆑ࣇࣝ࢜ࣟࢹ࢜࢟ࢩࢢࣝ ࢥ࣮ࢫ㸦)'*㸧ࡀᝏᛶ⭘⒆ࡔࡅ࡛࡞ࡃࠊάᛶ໬ 㸱㸬⤖ ᯝ ࣐ࢡࣟࣇ࢓࣮ࢪ࡞࡝⅖⑕⣽⬊ࡢάືᛶࡢᣦᶆ ᮏ◊✲ࡢᮏ᮶ࡢ㊃᪨ࡣᮍ◚⿣ື⬦⒗࡛࠶ࡗ ࡜ࡋ࡚⅖⑕⤌⧊࡟㞟✚ࡍࡿࡇ࡜ࡀ❑⏣࣭ᒣ⏣ࡽ ࡓࡀ ᖺኟ๓ᚋࡼࡾ ᖺ ᭶ࡲ࡛࡟᧜ᙳ ࡟ࡼࡾ᫂ࡽ࠿࡟ࡉࢀ࡚࠸ࡿࠋື⬦◳໬ࡢ୙Ᏻᐃ ࡉࢀࡓື⬦⒗⑕౛ࡣࠊゎ㞳ᛴᛶᮇ࠿ࡽ៏ᛶᮇࡲ ࣉ࣮ࣛࢡ࡟㹄㹂㹅ࡀ㞟✚ࡋࠊ἞⒪࡟ࡼࡾᨵၿࡍ ࡛ከᒱ࡟ཬࢇ࡛࠸ࡓࠋ ࡿࡇ࡜ࡶ 2JDZD ࡟ࡼࡾヲ⣽࡟ㄪ࡭ࡽࢀࠊᇶ♏ⓗ ᮇ㛫ෆࡢື⬦⒗ᝈ⪅ࡢ 3(7 ඲⑕౛ ࡞᳨ウࡣ኱ࡁࡃ㐍ᒎࡋࡓࠋ኱ື⬦⒗ᝈ⪅ࡢ㹎㹃 ື⬦⒗ゎ㞳ᚋࡢᛴᛶᮇ ౛ 㹒◊✲࡛ࡣ⑕≧ࡢ࠶ࡿື⬦⒗࡛㹄㹂㹅㞟✚ࡀ ື⬦⒗ࢫࢸࣥࢺ἞⒪๓ᚋ ౛ 㧗࠸ࡇ࡜ࡀሗ࿌ࡉࢀࡓࠋ ࢫࢸࣥࢺ἞⒪๓ ౛ ࢫࢸࣥࢺᚋࠊṧᏑ⒗ ౛ ⸆๣ ))'* ࡀࠊ⭘⒆ࡔࡅ࡛࡞ࡃ⅖⑕⣽⬊ࡢά ୙᫂⇕ࠊࢢࣛࣇࢺឤᰁ␲ 㸰౛ ືᛶࡢᣦᶆ࡜ࡋ࡚⅖⑕⤌⧊࡟㞟✚ࡍࡿࡇ࡜ࢆ ྜィ ౛ ฼⏝ࡋࠊື⬦⒗ᝈ⪅ࡢື⬦ቨࡢ⅖⑕ࡢ⛬ᗘࢆデ ᮏ◊✲࡛ࡣ⢾௦ㅰࡢᣦᶆ࡜࡞ࡿ㹎㹃㹒デ᩿ ᩿ࡍࡿ᪉ἲࢆ᳨ウࡍࡿࠋࡇࢀ࡟ࡼࡾᑠᚄ኱ື⬦ )'*3(7 ࡟࠾ࡅࡿື⬦ቨ࡬ࡢ )'* 㞟✚ࡢᡤぢ ⒗ࡢ᪂ࡓ࡞⑓ែデ᩿ἲࢆ㛤Ⓨࡋࠊࢧ࢖ࣞࣥࢺ࡞ ࡀࠊ⮫ᗋⓗ࡟࡝ࡢࡼ࠺࡞ព࿡ྜ࠸ࢆࡶࡕࠊ⮫ᗋ ࡲࡲ࡟㐍⾜ࡢ༴㝤ࡢ࠶ࡿάືᛶࡢື⬦⒗࡜ࠊᏳ ⤒㐣࡜࡝ࡢࡼ࠺࡟ᑐẚ࡛ࡁࡿ࠿ࡀၥ㢟࡞ࡿࠋࡇ ᐃᛶࡢ㧗࠸ື⬦⒗ࢆ㆑ูࡍࡿ᪉ἲࢆ᳨ウࡍࡿࠋ ࡢⅬ࡛ࡣࠊ㛗ᮇ࡟ཬࡪ⤒㐣ほᐹ࡜ࡢᑐẚࡀᚲ㡲 ࡛༢࡞ࡿᡤぢࡢゎᯒ࡛ࡣព⩏ࡀ࠺ࡍ࠸ࠋ୍᪉ࠊ 㸰㸬᪉ ἲ ᛴᛶᮇ⑕౛ࡢศᯒࡣ⅖⑕ࡢࡶࡗ࡜ࡶάືᛶࡢ ኱ື⬦⒗ࡀ࠶ࡾᮏ◊✲ࡢ㊃᪨࡟㈉⊩ࡍࡿ࡜ 㧗࠸᫬ࡢᡤぢࢆぢ࡚࠾ࡾࠊ⮫ᗋ⤒㐣࡜ࡢᑐẚࡀ ୺἞་࡟ุ᩿ࡉࢀࠊྠពࡢᚓࡽࢀࡓᝈ⪅࡟ ẚ㍑ⓗᐜ࡛᫆࠶ࡿ࡜࠸࠺฼Ⅼࡀ࠶ࡿࠋᡤぢ࡜ࡋ )'*3(7 ᳨ᰝࢆ᪋⾜ࡋࡓࠋ࣮ ᫬㛫ࡢ⤯㣗ᚋࠊ ࡚ࠊゎ㞳㒊ࡼࡾࡣࡑࡢ㎶⦕࡟ )'* ࡢ㧗㞟✚⑓ᕢ ᙜ㝔ࡢࢧ࢖ࢡࣟࢺ࣭ࣟࣥ࣍ࢵࢺࣛ࣎࡟࡚〇㐀ࡉ ࡀㄆࡵࡽࢀࡿഴྥࡀ࠶ࡿࠋ ࢀࡓ ))'* ࢆ 0%T 㟼⬦ὀᑕࡋࠊ ᫬㛫ᚋࠊ ࠾ࡼࡧ ᫬㛫ᚋ࡟᧜ᙳࡋࡓࠋ ࡇࢀࡽࡢ⑕౛ࡢࡲ࡜ࡲࡗࡓศᯒࡣḟᮇࡢㄢ㢟࡜ࡋࠊᮏሗ࿌࡛ࡣࠊᛴᛶᮇ࡟ )'*3(7 ࢆ᧜ᙳ ࡇࡢ᧜ᙳࣉࣟࢺࢥ࣮ࣝࡦ࡜ࡘࢆぢ࡚ࡶࠊ㹄㹂 ࡋࠊࡑࡢ㝿࡟ )'* 㞟✚ࡀ㧗࠿ࡗࡓ㒊఩ࡀ 㐌ᚋ 㹅ᢞ୚ᚋࠊ ศࠊ ᫬㛫ࠊ ᫬㛫࡜ሗ࿌࡟ࡼࡾ ࡟෌ゎ㞳ࡋࠊ)'* 㞟✚ࡀቨࡢ⬤ᙅᛶࢆ཯ᫎࡋ࡚ ࡤࡽࡤࡽ࡛࠶ࡾࠊ᭱㏆Ⓨ⾲ࡉࢀࡓㄽᩥ࡛ࡣ ࠸ࡓࡇ࡜ࡀ᫂♧ࡉࢀࡓ ౛ࢆሗ࿌ࡍࡿࠋ ศ࡛ࡼ࠸࡜ሗ࿌ࡉࢀࡓࡀࠊᡃࠎࡢ⤒㦂࡛ࡣ኱ື ⬦ෆࡢ⾑ᾮࣉ࣮ࣝࡢᨺᑕ⬟ࡀୗࡀࡽ࡞࠸࡜ቨ ⑕౛ሗ࿌ ࡬ࡢ㞟✚ࡢホ౯ࡀᅔ㞴࡞⑕౛ࡀ࠶ࡾࠊ㐜࠸᫬㛫 ṓ௦ዪᛶ㸸⊃ᚰ⑕࡟࡚ ᖺࡼࡾ㏻㝔ࠊᢞ - 219 - ⸆୰ࠋ ᖺ ᭶⫼㒊③ࢆక࠺⬚③ࡀฟ⌧ࡋࠊ ᩆᛴ᮶㝔ࠋࢽࢺࣟࢢࣜࢭࣜࣥࡢ⯉ୗᢞ୚࡟࡚⑕ ≧ᨵၿࡏࡎࠊࣔࣝࣄࢿᢞ୚࡟࡚㙠③ࡀᅗࡽࢀࡓࠋ ᮶㝔᫬㐀ᙳ &7 ࡛ࡣୖ⾜࠿ࡽୗ⾜⬚㒊኱ື⬦ ࡢᚄࡢᣑ኱ࠊ࠾ࡼࡧ⭈ື⬦ศᒱ௨ୗࡢ⭡㒊኱ື ⬦ࡢᚄࡢᣑ኱ࡀࡳࡽࢀࡓࠋ Ⓨ⑕ ᪥ᚋࡢ 3(7&7 ࡛ࡣࠊୖ⾜኱ື⬦ࠊᘪ㒊ࠊୗ⾜⬚㒊኱ື⬦ࡢቨ ࡢࡧ៏ᛶࡢ )'* 㧗㞟✚࡟ຍ࠼࡚ࠊᩘ⟠ᡤ࡟㧗࠸ )'* 㞟✚ࡀㄆࡵࡽࢀ௒ᅇࡢ⑓ᕢ࡜⪃࠼ࡽࢀࡓࠋ ୗ⾜⬚㒊኱ື⬦ࡢ㧗㞟✚㒊࡟ࡣࠊ㐀ᙳ &7 ࡟࡚ ⾑ᰦ࡟ࡼࡾ⫧ཌࡋࡓቨࡢ₽⒆ᙧᡂ࡜ᛮࢃࢀࡿ ࣏ࢣࢵࢺ≧ࡢᵓ㐀ࡀぢࡽࢀࠊ⅖⑕ᕢࢆᛮࢃࡏࡓࠋ ୖ⾜኱ື⬦ࡢ⫼ഃቨ࡟ࡣ㧗࠸㞟✚ࡀㄆࡵࡽࢀ ࡓࡀ㐀ᙳ &7 ࡛ࡣᡤぢࡀ࡞࠿ࡗࡓࠊࡋ࠿ࡋࠊධ 㝔୰࡟෌ᗘ⬚③Ⓨసࡀ⏕ࡌࠊ3(7㸫&7 ࡢ ᪥ᚋ ࡢ㐀ᙳ &7 ෌᳨ᰝ࡛ࡣࠊࡲࡉࡋࡃ )'* ࡢ㧗㞟✚ ࡀぢࡽࢀࡓ㒊఩࠿ࡽୖ⾜኱ື⬦࡟᪂ࡓ࡞ゎ㞳 ࡀ⏕ࡌ࡚࠾ࡾࠊ)'* 㞟✚ࡀቨࡢ⅖⑕ࡢάືᛶࠊ ゎ㞳ࡢ༴㝤ᛶࢆ♧ࡋ࡚࠸ࡓࡢ࡛ࡣ࡞࠸࠿࡜⪃ ࠼ࡽࢀࡓࠋ㐣ཤࡢ &7 ⏬ീ࡜ࡢẚ㍑࡛ࠊ㝞ᪧᛶ ᅗ )'*࣮3(7 ⏬ീࠊ ᙜึࡢ㐀ᙳ &7 ࡛ࡣᡤぢ࡞ࡋࠋ ᅗ㸸෌Ⓨసᚋࡢ㐀ᙳ &7 ࡛ࡣゎ㞳ࡀ⏕ࡌࡓࠋ ࡢື⬦⒗࡜デ᩿ࡉࢀࡓ⭡㒊ࡢື⬦⒗㒊ศ࡟ࡣ ࡲࡗࡓࡃ )'* 㞟✚ࡀࡳࡽࢀ࡞࠿ࡗࡓࠋ 㸳㸬⪃ ᐹ - 220 - ᮏሗ࿌࡛ࡣࠊᖹᡂ ᖺᗘࡢ኱ື⬦⒗⑕౛ࡢ )'*3(7 ᳨ᰝ≧ἣ࡜ࠊ௒ᚋࡢゎᯒࡢ᪉㔪ࢆ♧ࡍ ࡜࡜ࡶ࡟ࠊ඾ᆺⓗ࡞⑕౛ࡢሗ࿌ࢆ⾜ࡗࡓࠋື⬦ ⒗ࡢゎ㞳⑓ᕢࠊ≉࡟ࡑࡢ㎶⦕௜㏆࡟ࡣ⅖⑕཯ᛂ ࢆ཯ᫎࡋ࡚ࠊ㧗࠸ )'* 㞟✚ࡀㄆࡵࡽࢀࡿࡇ࡜ࡀ ከ࠸ࠋࡇࢀࡽࡢᡤぢࡀ༢࡞ࡿゎ㞳ࡢ⤖ᯝ⏕ࡌࡓ ᡤぢ࡛ࡣ࡞ࡃࠊ௒ᚋࡢ⑓ᕢࡢ㐍ᒎࢆண ࡍࡿྍ ⬟ᛶࡀ࠶ࡿࡇ࡜ࡀᮏ౛࡟ࡼࡾ᥎ᐹࡉࢀࡓࠋ 㸴㸬ࡲ࡜ࡵ ᮏ◊✲࡛ࡣࠊ኱つᶍ࡞ 0DVVVWXG\ ࡼࡾࡣࠊ ಶࠎࡢ⑕౛ࡢ㹎㹃㹒ᡤぢࡀఱࢆព࿡ࡋ࡚࠸ࡿ ࡢ࠿ࠊ⤒㐣ほᐹࠊ᳨ᰝᡤぢ࠾ࡼࡧ㐀ᙳ㹁㹒࡞࡝ ࡜ࡢẚ㍑࡟ࡶ࡜ࡎࡃ⢭ᐦ࡞⑕౛◊✲࡟ࡼࡾࠊ኱ ື⬦⒗࡟࠾ࡅࡿ㹄㹂㹅㸫㹎㹃㹒ࡢព⩏ࢆ᫂ࡽ ࠿࡟ࡋࠊ)'*3(7 ࡟ࡼࡿື⬦⒗ࡢ㐍ᒎࡢ༴㝤ᗘ ࡢண ࡀ࡛ࡁ࡞࠸࠿ࢆ᥈ࡿࡇ࡜ࡀ┠ᶆ࡜࡞ࡿ ࡜⪃࠼࡚࠸ࡿࠋ 㸵㸬ཧ⪃ᩥ⊩ ቑ⏣㝧Ꮚࠊㅖᒸ㒔ࠊ㛛⬥ᣅࠊ⏣Ᏺ၏୍ࠊᘅỤ㐨 ᫛ࠊᮌᮧኊ௓ࠊ❑⏣࿴㞝ࠋᛴᛶ኱ື⬦ゎ㞳ࠊ⭡ 㒊኱ື⬦⒗ྜే⑕౛࡟࠾࠸࡚ )'*3(7&7 ࡀ෌ ゎ㞳ࡢデ᩿࡟᭷⏝࡛࠶ࡗࡓ୍౛ࠋ ᖺ ᭶➨ ᅇ᪥ᮏ᰾་Ꮫ఍ࠊ⑕౛ሗ࿌ࠋ - 221 - 㸦21 ᣦ-117㸧⒗ቨࡢ⑓⌮Ꮫⓗデ᩿ ศᢸ◊✲⪅㸸㐲⸨ஂᏊ 㸯㸬┠ ⓗ [⤌⧊Ꮫⓗ◊✲] ⾑⟶࡛ࡣ⢛⭘ࡢ᭷↓ࠊྠ㒊ᾐ ኱ື⬦⒗ࡣ࣓ࢱ࣎ࣜࢵࢡ⑕ೃ⩌ࡢ ࡘ࡜ࡢ௬ㄝ࡛ࠊ ₶⣽⬊ࡢ✀㢮ࡸ➽⣽⬊ࡢ㛵୚ࡢ᭷↓ࠊ⢓ᾮኚ ᑠࡉ࡞⒗ቨ࡜ᡭ⾡࡟࡞ࡿࡼ࠺࡞኱ࡁ࡞ࡶࡢ࡜ࡢᙧ ᛶ࡞࡝ࡢ᭷↓ࢆ᳨ウࡍࡿࠋື⬦◳໬ࡢᙉ࠸౛ࠊ ែᏛⓗ࡞ẚ㍑ࢆᇶ࡟ ᑠཱྀᚄ኱ື⬦⒗ࡢᣑ኱せ ᙅ࠸౛࡛ࡢ኱ື⬦ቨ࡛ࡢࢸࢿ࣮ࢩࣥࡢⓎ⌧ ᅉࢆᙧែⓗ࡟᳨ウࡍࡿࡢࡀᮏ◊✲ࡢ┠ⓗ࡛࠶ࡿࠋ ࡢẚ㍑ࠊࢸࢿ࣮ࢩࣥࡢⓎ⌧ᚋ࡟⏕ࡌࡿ࡜࠸࠺ ኱ື⬦◳໬ࡣᖺ㱋࡜࡜ࡶ࡟㢧ⴭ໬ࡋࠊㄆࡵࡽࢀ࡞ Ș̺SMA㸦Ș̺smooth muscle actin㸧ࡢⓎ ࠸⑕౛ࡣ࡯ࡰ඲ࡃ࡞࠸ࠋࡋ࠿ࡋᚲࡎࡋࡶᆒ୍࡟㐍 ⌧ࢆ᳨ウࡍࡿࠋ௒ᅇච␿ᰁⰍࡢヨࡳ࡜ࡋ࡚ࠊ ࡴࡶࡢ࡛ࡣ࡞ࡃࠊ㌟యࡢ୰࡛ࡢ㒊఩࡟ࡼࡗ࡚ࡶࠊ ๗᳨⑕౛ࡢື⬦◳໬ࡢ࠶ࡿ⾑⟶⤌⧊ࢆ⏝࠸ ྛே࡟ࡼࡗ࡚ࡶ␗࡞ࡿࠋ᫬࡟㢧ⴭ࡞ࡶࡢࡀ࠶ࡾࠊ ࡚ᢠࢸࢿ࣮ࢩࣥ C ᢠయ㸦IBL ♫㸧ࠊȘ̺SMA ࡑࡢሙྜ࡟ࡣື⬦⒗ࢆᙧᡂࡍࡿ㢖ᗘࡣ㧗࠸࡜⪃࠼ 㸦Dako ♫㸧࡛ࡢᰁⰍࢆヨࡳࡓࠋ ࡿࠋ⒗ᙧ࡟ࡣ඲యⓗ࡟ᣑᙇࡍࡿࡶࡢ࠿ࡽࠊ୍ഃ࡟ 㣕ࡧฟࡍࡶࡢ࡞࡝ࡀ࠶ࡿࠋ 㸱㸬⤖ ᯝ ኱ື⬦⒗ࡣᙧᡂࡉࢀࢀࡤ⏕࿨ࢆ⬣࠿ࡍࡶࡢ ᚰ➽᱾ሰࡢ࠶ࡿ 80 ṓ⏨ᛶ๗᳨⑕౛ࡢ኱ື⬦ ࡛ࠊ⌧≧࡛ࡣᡭ⾡࡛◚⿣ࢆ㜵ࡄࡋ࠿᪉ἲࡣ࡞ ቨࠋᙎᛶ⧄⥔ᰁⰍ㸦EVGЎ㸧࡛ࡣෆ⭷࡟⢛⭘ ࡃࠊࡇࢀࡽ⑌ᝈࢆண㜵࡛ࡁࢀࡤࡑࢀ࡟㉺ࡋࡓ ࡀ࠶ࡿࠋ ࡇ࡜ࡀ࡞࠸ࠋ๗᳨⑕౛ࠊ࠶ࡿ࠸ࡣᡭ⾡⑕౛ࡢ ᙧែീࢆ࡜࠾ࡋ࡚ࠊື⬦⒗ࡢᙧᡂࡢ࣓࢝ࢽࢬ ࣒ࠊ⤒㐣ࠊቑᝏᅉᏊ࡟᳨ウࢆຍ࠼ࡿࠋ୰࡛ࡶ ⮚ჾಟ᚟ࡢ࣓࢝ࢽࢬ࣒ࡢ 1 ࡘ࡟㛫㉁࡟Ⓨ⌧ࡍ ࡿࢸࢿ࣮ࢩࣥࡢᙺ๭ࡀὀ┠ࡉࢀ࡚࠾ࡾࠊᚰ➽ ᱾ሰ࡛ࡣࢸࢿ࣮ࢩࣥࡢ⤌⧊࡟࠾ࡅࡿᙉᗘ࡜ ⾑୰ືែࡣ⑌ᝈࡢணᚋ࡟㛵㐃ࡍࡿ࡜࠸࠺ࠋ 㸰㸬᪉ ἲ [ᑐ㇟]ᅜ❧ᅜ㝿་⒪ࢭࣥࢱ࣮ᡞᒣ⑓㝔࡛ࡢ㐣 ྠ㒊ࡢ HE ᰁⰍ㸦Ў㸧 ཤ 5 ᖺ㛫ࡢ㐃⥆๗᳨⑕౛ࡢ୰࡟ࡣ⮫ᗋ࡛ᣦ᦬ ࡉࢀࡿᵝ࡞኱ື⬦⒗ࡢ⑕౛ࡀ 10 ౛⛬ᗘ࠶ࡿࠋ ࡲࡓ㐣ཤ 5 ᖺ㛫ࡢᡭ⾡⑕౛࡛ࡣࠊ኱ື⬦⒗࠶ ࡿ࠸ࡣື⬦◳໬࡛ᡭ⾡ࡉࢀࠊ⮫ᗋ᳨ᰝ㒊⑓⌮ ᳨ᰝᐊ࡟᳨యࡢᥦฟࡉࢀࡓ⑕౛ࡣ⣙ 25 ౛⛬ ࠶ࡿࠋ ࡇࢀࡽ⑕౛ࡢᙧែീࡢᡤぢࠊ⑕౛㛫ࡢẚ㍑ࠊ ᡭ⾡⑕౛࡟ࡘ࠸࡚ࡣࠊ᭦࡟⌧ᅾࡢ≧ἣ㸦⾑୰ ᅉᏊࡸࠊ⏬ീ➼㸧࡜ࡢ᳨ウࢆࡶヨࡳࡿࠋ - 222 - ྠ㒊ࡢᢠࢸࢿ࣮ࢩࣥᢠయ࡟ࡼࡿච␿ᰁⰍ࡛ 7DPDRND0,PDQDND<RVKLGD.<RNR\DPD ࡣ㸦Ў㸧ࠊᰁⰍᛶ࡟ᙉᙅࡀ࠶ࡾࠊෆ㒊ࡢ୙ᆒ .1LVKLRND7,QDGD++LURH06DNDNXUD ୍ᛶࡀࡼࡾ᫂░࡜࡞ࡿࠋ 7 DQG <RVKLGD 77HQDVFLQ& UHJXODWHV UHFUXLWPHQW RI P\RILEUREODVWV GXULQJ WLVVXHUHSDLUDIWHUP\RFDUFLDOLQMXU\$P -SDWKRO )XMLPRWR12QLVKL.+LURH0HWDO ,QFUHPHQWDO SURJQRVWLF YDOXHV RI VHUXP WHQHVFLQ& OHYHOV ZLWK EORRG %W\SH QDWULXUHWLFSHSWLGHWHVWLQJDWGLVFKDUJH LQ SDWLHQWV ZLWK GLODWHG FDUGLRP\RSDWK\ DQGGHFRPSHQVDWHGKHDUWIDLOXUH-&DUG )DLO Ș̺SMA ࡢᰁⰍ㸦Ў㸧࡛ࡣࠊᢠࢸࢿ࣮ࢩࣥ ᢠయ࡜㝧ᛶ㒊఩ࡀ␗࡞ࡿࠋ 㸲㸬⪃ᐹ ኱ື⬦ቨ࡟ࡘ࠸࡚ࠊࢸࢿ࣮ࢩࣥࡢⓎ⌧ࠊȘ̺ SMA ࡢⓎ⌧ࢆච␿ᰁⰍ࡛ヨࡳࡓࠋ௒ᚋࡣከ ᩘ౛࡛ࡢ᳨ウࢆຍ࠼ࡓ࠸ࠋࡲࡓ㧗⾑ᅽࠊ⢾ᒀ ⑓ࠊ㧗⬡⾑₢࡜ࡢ㛵㐃ࡶ᳨ウࡋ࡚࠸ࡃணᐃ࡛ ࠶ࡿࠋ ཧ⪃ᩥ⊩ 'DOPDQ5/7HGHVFR000\HUV-7D\ORU &$$$$GLVHDVH0HFKDQLVPVWUDWLILFDWLRQ DQG WUHDWPHQW $QQ1<$FDG6FL - 223 - 㸦 ᣦ 㸧ᑠᚄ⒗ࡢ⮬↛Ṕㄪᰝ ศᢸ◊✲⪅㔜ᯇ ᏹ 㸪┠ⓗ ࡓ㸬⏨ᛶ ౛㸪ዪᛶ ౛㸪ᖹᆒᖺ㱋 ṓ㸦 ኱ື⬦⒗ࡣእ⛉ⓗ⑌ᝈ࡜ࡉࢀ࡚࠸ࡿࡀ㸪ᑠཱྀᚄ ࠥ ṓ㸧㸬ึデ᫬⒗ᚄ FP ᮍ‶ࡢ⑕౛ࡣ ౛㸪FP ኱ື⬦⒗࡟እ⛉㐺ᛂࡣ࡞ࡃ㸪↓⑕≧࡛࠶ࡿࡀᨾ࡟ ௨ୖ FP ᮍ‶ࡀ ౛㸪FP ௨ୖࡀ ౛࡛࠶ࡗࡓ㸬 ₯ᅾⓗ࡞⑕౛ᩘࡣከ࠸࡜ᛮࢃࢀࡿ㸬ᑠᚄ⒗ࡢᝈ⪅ ⒗ᚄᣑ኱㏿ᗘࡣࡑࢀࡒࢀ PPᖺ㸪PPᖺ㸪 ࡣᑗ᮶ࡢᣑ኱㺃◚⿣㺃✺↛Ṛࢆ༴᝹ࡋ࡚ࡢᚰ⌮ⓗ PPᖺ࡛࠶ࡗࡓ㸬ࡲࡓྠᵝ࡟㸪ࢫࢸࣥࢺࢢࣛࣇ ㈇ᢸࡶ኱ࡁ࠸ࡀ㸪⌧ᅾ㐍⾜ࢆᢚ࠼ࡿ἞⒪ἲࡣ࡞࠸㸬 ࢺෆᤄ⾡࡟ࡘ࠸࡚ࡶ⑕౛Ⓩ㘓ࢆ㛤ጞࡋ࡚࠸ࡿࡀ㸪 ᮏ◊✲࡛ࡣ㸪኱ື⬦⒗ࢆ⏕ά⩦័⑓ࡢᯟ⤌ࡳ࡛ᤊ ௨๓ᙜ㝔ࡶཧຍࡋࡓከ᪋タ◊✲࡛ࡣ㸪⾡ᚋ⒗ᚄኚ ࠼┤ࡋ㸪⑓ែゎᯒ㸪ᣑ኱ᅉᏊࡢ㏣ồ㸪↓౵く㺃ప ໬ࢆほᐹࡋᚓࡓ⭡㒊኱ື⬦⒗࡟ᑐࡍࡿࢫࢸࣥࢺ ࢥࢫࢺ἞⒪࡟㛵ࡍࡿ◊✲࡟ࡼࡾ㸪⒗ᣑ኱ࢆᢚไࡋ㸪 ࢢࣛࣇࢺෆᤄ⾡ ౛ࢆᑐ㇟࡜ࡋሗ࿌ࡋࡓ㸬ᖹᆒ ᝈ⪅ࡢᏳᚰ㸪་⒪㈝๐ῶ࡟㈉⊩ࡋࡓ࠸㸬 ᖺ㱋 ṓ㸪⏨ᛶ ౛㸪ዪᛶ ౛㸬ึᮇᡂ⦼ࡣ ␃⨨ᡂຌࡣ ౛㸦㸣㸧㸪ึᮇᡂຌࡣ ౛ 㸪᪉ἲ 㸦㸣㸧࡛࠶ࡗࡓ㸬⾡ᚋ 7\SH,HQGROHDN ࢆ ᙜ㝔࡛⤒㦂ࡋࡓᑠཱྀᚄ⭡㒊኱ື⬦⒗ࡢ⒗ᚄ⤒ ౛㸦㸣㸧࡟ㄆࡵ㸪7\SH,, ࢆ ౛㸦㸣㸧࡟ 㐣ࢆ &7 ࡟࡚ホ౯ࢆ⾜࠸㸪⒗ᚄ࡜ᣑ኱㏿ᗘ࡜ࡢ㛵ㄆࡵࡓ㸬 ᖺ௨ୖࡢ⤒㐣ほᐹࢆ⾜࡞ࡗࡓ⑕౛ࡣ 㐃ࢆィ ࡍࡿ㸬ࡲࡓ࣓ࢱ࣎ࣜࢵࢡ⑕ೃ⩌࡛ぢࡽࢀ ౛࡛㸪఩⨨⛣ືࡸ◚ᦆࢆㄆࡵࡓ⑕౛ࡣ࡞࠿ࡗࡓ㸬 ࡿྛ✀௦ㅰ␗ᖖ㸦⬡㉁௦ㅰ␗ᖖ㸪㧗⾑ᅽ㸪⪏⢾⬟ ⾡ᚋ PP ௨ୖࡢ⒗ᚄኚ໬ࢆㄆࡵࡓ⑕౛ࡣ⒗⦰ᑠ 㞀ᐖ㸪⫧‶➼㸧㸪༴㝤ᅉᏊ㸦ᖺ㱋㸪ႚ↮➼㸧࠾ࡼ ౛㸦㸣㸧㸪ኚ໬࡞ࡋ ౛㸦㸣㸧㸪ᣑ኱ࡀ ࡧᝈ⪅⫼ᬒ㸦⭈㞀ᐖ➼ྜే⑌ᝈ㸪ᐙ᪘Ṕ㸧ࡢ㛵㐃 ౛㸦㸣㸧࡛࠶ࡗࡓ㸬 ࡟ࡘ࠸࡚ࡶホ౯ࢆ⾜ࡗࡓ㸬ࡲࡓࢫࢸࣥࢺࢢࣛࣇࢺ ෆᤄ⾡ᚋࡢ⒗ᚄኚ໬࡟ࡘ࠸࡚ࡶ &7 ࡟࡚ホ౯ࢆ⾜㸪⪃ᐹ ࠸㸪HQGROHDN ࡜ࡢ㛵㐃ࡸ⾡๓⒗ᚄ࡜ࡢ㛵ಀ㸪ࢹࣂ ⭡㒊኱ື⬦⒗ࡢ⒗ᚄᣑ኱㏿ᗘࡣ㸪⒗ࡀቑ኱ࡍࡿ ࢖ࢫ࡜ࡢ┦㛵࡟ࡘ࠸࡚ࡶホ౯ࢆ⾜࡞࠺㸬ࡲࡓ኱ື ࡟ᚑࡗ࡚㏿ࡃ࡞ࡿഴྥ࡟࠶ࡾ㸪FP ࢆ㉸࠼ࡿ࡜ᛴ ⬦⒗࡟࠾ࡅࡿ᪂ࡓ࡞⑓ែデ᩿࡜ࡋ࡚ᮇᚅࡉࢀ࡚ ㏿࡟ቑຍࡋࡓ㸬ࡇࡢࡇ࡜ࡼࡾ㸪᪥ᮏே࡟࠾࠸࡚ࡶ ࠸ࡿࢸࢿ࢖ࢩࣥ㹁ࡢ⑓ែࣂ࢖࣐࣮࣮࢜࢝࡜ࡋ࡚ ᡭ⾡㐺ᛂࡢ⒗ᚄࡣ FP ௨ୖ࡜ࡍࡿࡇ࡜ࡢጇᙜᛶࡀ ࡢ᭷⏝ᛶࢆᐇドࡋ㸪ศᏊᶵ⬟ࢆゎ᫂ࡋ࡚἞⒪ᶆⓗ ♧၀ࡉࢀࡓ㸬ࡲࡓḢ⡿࡛ࡣ⒗ᚄᣑ኱࡟㛵୚ࡍࡿᅉ ࡜ࡋ࡚ࡢ᭷⏝ᛶࢆ᳨ウࡍࡿ㸬 Ꮚ࡜ࡋ࡚ࡣ㸪㧗⾑ᅽ㸪ႚ↮㸪៏ᛶ㛢ሰᛶ⫵⑌ᝈ࡞ ࡝ࡀᣦ᦬ࡉࢀ࡚࠸ࡿࡀ㸪ࡇࢀࡲ࡛ࡢᡃࠎࡢ᳨ウ࡛ 㸪⤖ᯝ ࡣ㸪⑕౛ᩘࡀᑡ࡞࠸஦ࡶ࠶ࡾ☜ㄆ࡛ࡁ࡞࠿ࡗࡓ㸬 ⌧ᅾ⑕౛ࢆⓏ㘓ࡋ㸪㡰ḟ &7 ࡛ࡢゎᯒ㸪ࢸࢿ࢖ ௒ᚋ⑕౛ᩘࢆቑࡸࡋ㸪⫼ᬒᅉᏊ➼࡟ࡘ࠸࡚ヲ⣽࡞ ࢩࣥ & ࡢ᥇⾑ࢆ⾜࡞ࡗ࡚࠸ࡿ㸬௨๓ᙜ㝔࡛᪋⾜ࡋ ᳨ウࢆຍ࠼ࡓ࠸࡜⪃࠼࡚࠸ࡿ㸬 ࡓඛ⾜◊✲࡛ࡣ㸪ᑠཱྀᚄ⭡㒊኱ື⬦⒗࠾ࡼࡧ FP ௨ୖ࡛ࣁ࢖ࣜࢫࢡ࠶ࡿ࠸ࡣᡭ⾡ࢆᕼᮃࡋ࡞࠿ࡗ 㸪⤖ㄽ ࡓࡓࡵ⤒㐣ほᐹࢆ⾜࡞ࡗࡓ ౛ࡢ᳨ウࢆ⾜࡞ࡗ ⌧ᅾࡢ࡜ࡇࢁᑠཱྀᚄ኱ື⬦⒗ࡢ἞⒪ἲ࡟ࡣ᫂ - 224 - ☜࡞ࡶࡢࡣ࡞࠸ࡀ㸪ྛ✀௦ㅰ␗ᖖ㸦⬡㉁௦ㅰ␗ᖖ㸪㧗⾑ᅽ㸪⪏⢾⬟㞀ᐖ㸪⫧‶➼㸧㸪༴㝤ᅉᏊ㸦ᖺ㱋㸪 ႚ↮➼㸧࠾ࡼࡧᝈ⪅⫼ᬒ㸦⭈㞀ᐖ➼ྜే⑌ᝈ㸪ᐙ ᪘Ṕ㸧࡟ࡘ࠸࡚ࡢ᳨ウࢆ⾜࠸㸪௒ᚋࡶࡉࡽ࡟⑕౛ ᩘࢆቑࡸࡋ᳨ウࢆຍ࠼࡚࠸ࡁࡓ࠸㸬ࡲࡓ⑓ែࣂ࢖ ࣐࣮࣮࡛࢜࢝࠶ࡿࢸࢿ࢖ࢩࣥ & ࡟ࡘ࠸࡚ࡶ㸪ࡑࡢ ್ࡸኚ໬࡞࡝࡟ࡘ࠸࡚ࡶホ౯ࡋ㸪HQGROHDN ࡢ᭷↓㸪 ⒗ෆ⾑ᰦ໬≧ែࡢኚ໬㸪⒗ᣑ኱⦰ᑠࡢ⛬ᗘ㸪࡟ࡘ ࠸࡚ࡶ᳨ウࡋ࡚࠸ࡁࡓ࠸㸬 - 225 - 㸦 21 ᣦ 117㸧 ᪂ ࡋ ࠸ ⑓ ែ デ ᩿ ἲ ࡢ ⮫ ᗋ ヨ㦂 ศᢸ◊✲⪅㸸௒୰ᜤᏊ 㸯㸬┠ⓗ ࢭ ࣝ ⌮ㄽ ࡟ᚑ ࠸ࠊ ṇᖖᚄ 㒊 ࠊ⅖ ⑕ࢰ ࣮ࣥ ࠊ ⾑ ⟶ࡣ 㸪⣽ ⬊࡜ ࡑࡢ࿘ ᅖ ࡢ⣽ ⬊እ ࣐ࢺ ࣜ ά ື ࢰ࣮ ࣥࠊ ↓ᵓ 㐀ࢰ࣮ ࣥ ࡢ㸲 ࡘࡢ ࢫࢸ ࣮ ࢡ ࢫ ࠿ࡽ ᵓᡂ ࡉࢀ ࠊ࣐ࢺ ࣜ ࢡࢫ ᡂศ ࡣᵓ 㐀 ࢪ࡟ศ㢮ࡋࡓࠋ ࢆ ᨭ ࠼ࠊ ⾑⟶ ࡢᙎ ᛶࠊఙ ᒎ ᛶࠊ ᙇຊ ࡜࠸ ࡗ ࡓ ≀ ⌮≉ ᛶࢆ Ỵᐃ ࡋ࡚࠸ ࡿ ࠋ኱ ື⬦ ⒗ቨ ࡛ ࡣ ࠊ ៏ᛶ ⅖⑕ ࡟క ࡗ࡚ά ᛶ ໬ࡉ ࢀࡓ ࢱࣥ ࣃ ࢡ ศ ゎ㓝 ⣲ࡀ ࠊᨭ ᣢ⤌⧊ ࡛ ࠶ࡿ ⣽⬊ እ࣐ ࢺ ࣜ ࢡ ࢫࢆ ◚ቯ ࠊ⾑ ⟶ቨࡢ ⤌ ⧊⬤ ᙅᛶ ࢆࡁ ࡓ ࡋ࡚ᙧᡂࡉࢀࡿ࡜⪃࠼ࡽࢀ࡚࠸ࡿࠋᚑ ࡗ࡚ ࠊ ࣐ ࢺ ࣜ ࢡࢫ ࡢ ືែ ࡣ ኱ື⬦ 㐍 ᒎ ࢆᕥ ྑ ࡍࡿ 㔜せ ࡞ ᅉ Ꮚ࡛ ࠶ ࡾ 㸪 ࣐ ࢺࣜࢡ ࢫ ື ែࡢ ṇ ☜࡞ ホ ౯ࡣ⑓ែ㐍ᒎࡢᣦᶆ࡟࡞ࡿࡇ࡜ࡀண᝿ࡉࢀ ࡿ ࠋ ࡑࡇ ࡛ᮏ ◊✲ ࡛ࡣ㸪 ኱ ື⬦ ⒗ࡢ 㐍⾜㸪 ⑓ ᮇ ࢆุ ᐃࡍ ࡿⅭ ࡟ᝈ⪅ ⾑ ୰࡛ ᐃ ྍ⬟ ࡞ ࢸ ࢿ ࢖ ࢩࣥ & ࡢ 㑅ᢥ ⓗ ࢫࣉ ࣛ ࢖ ࢩࣥ ࢢ 㒊఩ ᪂つ ࣐ ࢺ ࣜࢡ ࢫ ືែ ࣐ ࣮࢝ ࣮ ࢆ 㛤Ⓨ ࡋ 㸪ࡑ ࡢ ≉ ␗ ⓗ ᢠయ 㸲 &㸶 ࢆ ⏝࠸࡚ ච ␿ ᰁⰍ ࢆ ⾜࠸ࠊࢸ ᭷ ⏝ ᛶ ࢆ᳨ ド ࡍࡿ ࡇ ࡜ࢆ┠ ⓗ ࡜ ࡍࡿ ࠋ ⣽⬊ እ ࢿ ࢖ ࢩ ࣥ & ࡀ ࡝ ࡢࢫ ࢸ ࣮ࢪ ࡢ ࡝ ࡢ㒊 ఩ ࡟Ⓨ ⌧ ࣐ ࢺ ࣜ ࢡࢫ ศ Ꮚࡢ ࠺ ࡕࠊ⅖ ⑕ ࡟ క࠺ ⤌ ⧊ᵓ ⠏ ࡍ ࡿ ࠿ ᳨ウ ࡋ ࡓࠋ ᵓ ⠏ ࡢ ෌Ⓨ ⌧ ࡋ㸪 ᙉ ࠸⏕≀ ά ᛶ ࢆᣢ ᆅ ⛒ᘧ ࣜ 㸰㸧 ᅜ❧ ᅜ㝿 ་⒪ ࢭࣥࢱ ࣮ ࢆཷ デࡋ ࡓ⭡ 㒊 ࣔࢹࣜࣥࢢࢆไᚚࡍࡿࡇ࡜ࡀ▱ࡽࢀ࡚࠸ࡿ ࠾ ࡼ ࡧ⬚ 㒊኱ ື⬦ ⬦⒗ᝈ ⪅ ࡢ⾑ Ύࢸ ࢿ࢖ ࢩ 0DWULFHOOXODUࢱ ࣥ ࣃࢡ⩌ ࠊ ࡑ ࡢ୰ ࡛ ࡶ≉ ࡟ ࣥ & ⃰ᗘࠊ࠾ࡼࡧ⾑₢ 003 ⃰ᗘࢆ (/,6$ ἲ ࢸ ࢿ ࢖ ࢩࣥ & ࡟ ὀ┠ ࡋ ࠊ኱ ື ⬦ ⒗ᝈ ⪅ ࡢ⾑ ୰ ࡟ࡼࡾ ᐃࡋࡓࠋ ⃰ ᗘ ࢆ ᐃ ࡋ ࡚⮫ ᗋ ീ࡜ᑐ ẚ ࡋ ᭷⏝ ᛶ ࢆホ ౯ 㸱㸬⤖ᯝ ࡍ ࡿ ࡜ ྠ᫬ ࡟ 㸪ᮏ ᖺ ᗘࡣ኱ ື ⬦ ⒗⤌ ⧊ ࢆゎ ᯒ 㸯㸧ṇ ᖖᚄ 㒊࡛ ࡣ୰⭷ ࡟ ࡣ᫂ ࡽ࠿ ࡞ኚ ໬ ࡋ ࢸ ࢿ ࢖ࢩ ࣥ & Ⓨ⌧ ࡢ ኚ໬ ࡀ ኱ ື⬦ ⒗ ᙧᡂ 㐣 ࡀ ぢ ࡽࢀ ࡞࠸ ࡀ㸪 ෆ⭷࡟ ჾ ㉁໬ ࢆక ࠺⾑ ᰦ ⛬ ࡢ ࡝ ࡢẁ 㝵 ࡢ⏕ య ⌧㇟ࢆ ཯ ᫎ ࡍࡿ ࠿ ࢆ≉ ᐃ ᙧ ᡂ ࡀ㢧 ⴭ࡛ ࠶ࡗ ࡓࠋ୰ ⭷ ࡟࣐ ࢡࣟ ࣇ࢓ ࣮ ࡍ ࡿ ࡇ ࡜ࢆ ┠ ⓗ࡜ ࡋ ࡓࠋ ࢪ ࡢ ᾐ₶ ࡀࡳ ࡽࢀ ࡿ⅖⑕ ࢰ ࣮ࣥ ࡛ࡣ ᙎᛶ ኚ ໬ ࡟ ࡣ᫂ ࡽ࠿ ࡞ኚ ໬ࡀぢ ࡽ ࢀ࡞ ࠿ࡗ ࡓࠋ ⾑㸰㸬᪉ἲ ⟶ ᚄ 㸦⒗ ᚄ㸧 ࡢᣑ ኱࡟క ࠸ ࠊᙎ ᛶ⥺ ⥔ࡢ ᩿ 㸯㸧 ࣄࢺ ኱ື ⬦ ⒗ ษ 㝖ᶆ ᮏ ࢆస 〇ࡋ ࠊ ୰ ∦໬㸪◚ቯࡀࡳࡽࢀࠊ᭱ ኱ ᣑ ᙇ 㒊 ࡢ ⒗ ቨ ⭷ ࡟ ࡘ ࠸ ࡚ ࢚ ࣛ ࢫ ࢳ ࢝ ࣡ ࣥ ࢠ Ѹࢯ ࣥ ᰁ Ⰽ ࡟ ࡛ࡣ࢚ࣛࢫࢳࣥᙎᛶ⥺⥔ࡀ࡯ࡰ᏶඲࡟ ࡼ ࡿ ᙎᛶ ⥺⥔ ࡢ◚ ቯࡢ⛬ ᗘ ࠊ࠾ ࡼࡧ ච␿ ᰁ ᾘኻࠊ୰⭷ᖹ⁥➽⣽⬊ࡶᾘኻࡋ㸪⒗ቨ Ⰽ ࡟ ࡼࡾ ࣐ࢡ ࣟࣇ ࢓࣮ࢪ ࡢ ᾐ₶ ࠊ୰ ⭷ᖹ ⁥ ୰⭷ࡣ⭺ཎ⥺⥔࡜ෆ⭷⾑ᰦࡢჾ㉁໬࡟ ➽ ⣽ ⬊ࡢ 㓄ิ ࢆ㸱 Ⅼࢆᇶ ‽ ࡟ࠊ ࢱ࢖ ࣒࢝ ࣉ కࡗ࡚ືဨࡉࢀࡓ➽⥺⥔ⱆ⣽⬊࡜ᛮࢃ - 226 - ࢀࡿ⣽⬊࡟ࡼࡗ࡚ᵓᡂࡉࢀ࡚࠸ࡓࠋࢸ ࡃ ࡢ ⮚ჾ ࡢ⑌ ᝈ࡛ ⑓ែά ື ᛶࡢ ᣦᶆ ࡟࡞ ࡿ ࢿ ࢖ ࢩ ࣥ & ࡣ ṇᖖᚄ㒊࡛ࡶჾ㉁໬⾑ᰦ⤌ ࡔ ࡅ ࡛࡞ ࡃ㸪 ౛࠼ ࡤᚰ⮚ ࣜ ࣔࢹ ࣜࣥ ࢢᢚ ไ ⧊ ࡛ ᙉ࠸ Ⓨ⌧ ࡀࡳ ࡽࢀࡓ ࡀ ࠊ୰ ⭷࡟ ࡣࡳ ࡽ ἞ ⒪ ࡢᶆ ⓗศ Ꮚ࡜ ࡞ࡿࡇ ࡜ ࡀண ᝿ࡉ ࢀ࡚ ࠸ ࢀ ࡞ ࠿ࡗ ࡓࠋ ࡲࡓ 㸪ண᝿ እ ࡟㸪 ࣐ࢡ ࣟࣇ ࢓ ࡿࠋ௒ᅇࡢ◊✲࡟ࡼࡾࠊࢸࢿ࢖ࢩࣥ C ࡣ኱ ࣮ ࢪ ࡢᾐ ₶ࡀ ጞࡲ ࡿ᪩ᮇ ⅖ ⑕ࢰ ࣮ࣥ ୰⭷ ࡟ ື ⬦ ⒗ᙧ ᡂࡢ ⑓ែ ࡛㸪⅖ ⑕ ⣽⬊ ᾐ₶ ࡟క ࡗ ࡣ Ⓨ ⌧ࡏ ࡎࠊ ࡉࡽ ࡟⑓ែ ࡀ 㐍⾜ ࡋ㸪 ᙎᛶ ⥺ ࡚ ࡜ ࠸࠺ ࡼࡾ ࠊᙎ ᛶ⥺⥔ ⥺ ⥔ࢆ ୺య ࡜ࡍ ࡿ ⥔ ࡢ ┤⥺ ໬ࡀ ࡳࡽ ࢀࡿ㒊 ఩ ࠿ࡽ Ⓨ⌧ ࡀࡳ ࡽ ⾑ ⟶ ቨᵓ 㐀◚ ቯࡀ 㛤ጞࡍ ࡿ 㝿࡟ Ⓨ⌧ ࡀᛴ ୖ ࢀࡓࠋ ᪼ ࡍ ࡿࡇ ࡜ࡀ ᫂ࡽ ࠿࡟࡞ ࡾ 㸪༢ ࡞ࡿ ⅖⑕ ࣐ ࣮ ࢝ ࣮࡜ ࠸࠺ ࡼࡾ ⒗ᙧᡂ ࢆ ࡼࡾ ≉␗ ⓗ࡟ ཯ ᫎࡍࡿࡇ࡜ࡀ♧၀ࡉࢀࡓࠋ 㸳㸬⤖ㄽ M a t r i c e l lu l a r ࢱ ࣥ ࣃ ࢡ ࡢ ୍ ࡘ ࢸ ࢿ ࢖ ࢩࣥ C ࡣ኱ື⬦⒗ᙧᡂ㐍⾜ࡢ≉␗ⓗ࡞ ࣐ ࣮ ࢝ ࣮ ࡟࡞ࡾ࠺ࡿࠋ 㸴㸬◊✲Ⓨ⾲ཬࡧ≉チ ㄽᩥⓎ⾲ 1) ௒୰ᜤᏊࠊྜྷ⏣฼㏻. ⣽⬊እ࣐ࢺࣜࢵࢡ ࢫ࡜⅖⑕. ⾑⟶་Ꮫ 10: 249-256,2009 MMP9 ࡣࠊ⅖⑕⣽⬊ᾐ₶࡟క࠸Ⓨ⌧ࡀୖ᪼ 2) ௒୰-ྜྷ⏣ᜤᏊࠊྜྷ⏣฼㏻ Matricellular ࡍ ࡿ ഴྥ ࡣぢ ࡽࢀ ࡓࡀ㸪 ⑓ ᮇ㸪 ⤌⧊ ᵓ㐀 ࡢ ࢱࣥࣃࢡ㉁ ࡲࡍࡲࡍ㔜せ࡟࡞ࡿ⣽⬊ ◚ ቯ ࡟࡜ ࡶ࡞ ࠺ᛴ ⃭㸪≉ ␗ ⓗ࡞ ኚ໬ ࡣぢ ࡽ ࿘㎶⎔ቃ㸦⣽⬊ࢽࢵࢳ㸧ࡢ᭱᪂⛉Ꮫᢏ⾡ࠊ ࢀ࡞࠿ࡗࡓࠋ ⏣⏿Ὀᙪ⦅ ࣓ࢹ࢕࢝ࣝࢻࢗ㸪኱㜰 , 2)⌧ᅾࠊ10 ྡࡢᝈ⪅ࢆⓏ㘓ࡋ⾑Ύࡢࢸࢿ࢖ 2009,:. 206-210 ࢩࣥ C ࢆ ᐃࡋࡓࠋࡉࡽ࡟ᮾி་⛉኱Ꮫࡢ Ꮫ఍Ⓨ⾲ 40 ౛⑕౛ࢆ㏣ຍⓏ㘓ࡋ࡚⾑Ύࢸࢿ࢖ࢩࣥ C 1) Imanaka-Yoshida, K. Tenascin C as a ⃰ ᗘ ࢆ ᐃࡋ 㸪⮫ ᗋ⤒㐣 ࡜ ࡢᑐ ẚࢆ ⾜࠺ ண Target for Regulation of Cardiac ᐃ࡛⤒㐣ほᐹࢆ㛤ጞࡋࡓࠋ Remodeling. Keystone Symposia: Cardiovascular Development and Repairࠋ 2010 ᖺ 2 ᭶ 28 ᪥ —3 ᭶ 5 ᪥ ࠋ 㸲㸬⪃ᐹ Keystone, Colorado, ࢔࣓ࣜ࢝ྜ⾗ᅜ ୍ ⯡ ࡟ M a t r i c e l l u l ar ࢱ ࣥ ࣃ ࢡ ࡣ ⤌ ⧊യᐖ࡜⅖⑕࡟కࡗ࡚㧗Ⓨ⌧ࡍࡿഴྥ 2)௒ ୰ ᜤ Ꮚ ࠊ ᘅ Ụ 㐨 ᫛ . ⣽ ⬊ እ ࣐ ࢺ ࣜ ࢡ ࢫ ࡀぢࡽࢀࡿࡀࠊ୰࡛ࡶࢸࢿ࢖ࢩࣥ C ࡣ ࢸࢿ࢖ࢩࣥ C ࡟ࡼࡿ⥺⥔໬࣭⅖⑕࣭ච␿ ά ື ᛶ⅖ ⑕⑓ ࡟క ࡗ࡚ᴟ ࡵ ࡚≉ ␗ⓗ ࡟Ⓨ ⌧ ཯ᛂࡢไᚚ. ➨ 13 ᅇ᪥ᮏᚰ୙඲Ꮫ఍Ꮫ ࡋ ࠊ ⅖⑕ ཯ᛂ ࡢቑ ᖜᅉᏊ ࡜ ࡋ࡚ ാࡃ ࡞࡝ ከ ⾡㞟఍. 2009 ᖺ 10 ᭶ 30 ᪥—11 ᭶ 1 ᪥. ᙬ ࡞ ᶵ⬟ ࢆ♧ ࡋ㸪 ࡇࢀࡲ ࡛ ᚰ⮚ ࢆࡣ ࡌࡵ ከ ⚟ᒸ - 227 - 䠄21 ᣦ 117䠅㻌 ᇶ ♏ ⓗ ⑓ ែ ◊ ✲㻌 ศᢸ◊✲⪅䠖㟷ᮌᾈᶞ㻌㻌䠍䠊┠ⓗ㻌㏆䛿⤊ᮎീ䛸⪃䛘䜙䜜䜛䚹䛧䛯䛜䛳䛶䚸䠍ಶ䛾⒗⤌⧊ 㻌 ኱ື⬦⒗ᝈ⪅䛾኱༙䜢༨䜑䜛ᑠᚄ኱ື⬦⒗䛻ᑐ 䛿ᩘᖺ㛫䛾᫬㛫⤒㐣䜢ᑒ䛨㎸䜑䛯䛂⅖⑕䛾䝍䜲䝮䜹䛩䜛ຠᯝⓗ䛺἞⒪ἲ䛿↓䛟䚸᭷ຠ䛺⸆≀⒪ἲ䜒↓䛔䚹䛣䛾⌧≧ᡴ㛤䛾䛯䜑䛻䛿䚸ศᏊ⑓ែ䛻ᇶ䛵䛟㠉᪂ⓗ 䛺デ᩿䚸἞⒪ἲ䛾㛤Ⓨ䛜ᛴົ䛷䛒䜛䚹⏦ㄳ⪅䛜䛣䜜䜎䛷䛻ᚓ䛯◊✲ᡂᯝ䛿䚸⅖⑕䝅䜾䝘䝹䛜኱ື⬦⒗ 䛷୰ᚰⓗ䛺ᙺ๭䜢ᯝ䛯䛩䛣䛸䜢♧䛧䛶䛔䜛䚹ᮏ◊✲ 䛷䛿኱ື⬦⒗⑓ែ䛻䛚䛡䜛⅖⑕ᛶ⣽⬊ෆ䝅䜾䝘䝹䛾ゎ᫂䜢㏻䛨䛶䚸ศᏊデ᩿䛸ศᏊᶆⓗ἞⒪䛾㛤Ⓨ䜢 ┠ᣦ䛩䚹㻌䝥䝉䝹䛃䛸⪃䛘䜛䛣䛸䛜䛷䛝䚸䛣䜜䜢✵㛫ⓗ䛻ゎᯒ䛩䜛䛣䛸䛷䚸⒗䛾Ⓨ⑕䚸㐍⾜䛸䛔䛖᫬㛫ⓗ⤒㐣䛾ㅦ䜢ゎ䛟㘽䛜ᚓ䜙䜜䜛ྍ⬟ᛶ䛜䛒䜛䠄ᅗ 㻝䠅䚹䛣䛾ᴫᛕ䛻ᇶ䛵䛝䚸ᮏ◊✲䛷䛿ṇᖖᚄ㒊ศ䛛䜙᭱኱⒗ᚄ㒊ศ䜎䛷䚸㛗㍈䛻ἢ䛳䛶」ᩘ⟠ᡤ䛾⤌⧊䜢᥇ྲྀ䛩䜛䚹⒗⤌⧊ 䛿៏ᛶ⅖⑕䜢≉ᚩ䛸䛧䛶䛔䜛䛜䚸៏ᛶ⅖⑕୍⯡䛾ศ Ꮚⓗ䛺⌮ゎ䛿ᮍ䛰୙༑ศ䛷䛒䜛䚹㏫䛻䚸䛂⅖⑕䛾䝍䜲䝮䜹䝥䝉䝹䛃䛷䛒䜛኱ື⬦⒗䛾ゎᯒ䛻䜘䜚䚸៏ᛶ⅖ 㻌 ኱ື⬦⒗⤌⧊䛷䛿䚸ከ䛟䛾䝃䜲䝖䜹䜲䞁䜔䝇䝖䝺䝇䛜 ⅖⑕䜢ច㉳䛧䚸⑓ែ䜢㐍⾜䛥䛫䜛䚹䛭䛾୰᰾䛸䛺䜛⣽ ⬊ෆ䝅䜾䝘䝹䛾ゎ᫂䛿䚸⑓ែ䛾䝰䝙䝍䝸䞁䜾䠄ศᏊ デ᩿䠅䜔䚸⑓ែไᚚ䛻䜘䜛㠉᪂ⓗ䛺἞⒪䠄ศᏊᶆⓗ ἞⒪䠅䜢ྍ⬟䛻䛩䜛䚹ᮏ◊✲䛿䚸⏦ㄳ⪅⊂⮬䛾◊✲ ᡂᯝ䛻ᇶ䛵䛝䚸៏ᛶ⅖⑕䛸⣽⬊እ䝬䝖䝸䜽䝇䛾௦ㅰ ␗ᖖ䛻╔┠䛧䚸኱ື⬦⒗䛾ศᏊ⑓ែゎ᫂䛸ศᏊデ ᩿䞉ศᏊᶆⓗ἞⒪䛾ᐇ⌧䜢┠ᣦ䛩䚸ୡ⏺䛷䜒㢮䜢ぢ䛺䛔ィ⏬䛷䛒䜛䚹㻌 ⑕䛾ㅦゎ᫂䜈䛾✺◚ཱྀ䛜㛤䛛䜜䜛ྍ⬟ᛶ䛜䛒䜛䚹㻌㻌 ኱ື⬦ቨ⤌⧊䛿䚸⾑⟶ᖹ⁥➽⣽⬊䚸⾑⟶ෆ⓶⣽ ⬊䚸⥺⥔ⱆ⣽⬊➼䚸ከ✀㢮䛾⣽⬊䜢ྵ䜐䚹䛥䜙䛻⒗ ⑓ែ䛷䛿៏ᛶ⅖⑕䛻క䛔ከ✀㢮䛾⅖⑕⣽⬊䛜ᾐ₶ 䛧䛶䛔䜛䚹䛣䛾䜘䛖䛺」㞧䛺⑓ែ䜢ゎᯒ䛩䜛䛯䜑䛻䚸 ⑓⌮ീ䛸ᑐᛂ䛧䛯⥙⨶ⓗゎᯒ䜢⾜䛺䛖䚹㻌㻌㻌㻌㻌㻌䠎䠊᪉ἲ㻌㻌㻌 ⅖⑕ᛶ⣽⬊ෆ䝅䜾䝘䝹ศᏊ䛾ᶵ⬟䜢ከ㠃ⓗ䛻᳨ ウ䛩䜛䛯䜑䛻䚸䝠䝖኱ື⬦⒗⤌⧊䜢⏝䛔䜛䚹䝠䝖኱ື ⬦⒗⑓ែ䛻䛚䛡䜛᳨ウ䛾䛯䜑䛻䚸ேᕤ⾑⟶⨨᥮⾡䛾㝿䛻ᝈ⪅ᮏே䛾ྠព䜢ᚓ䛶኱ື⬦⒗⤌⧊䜢᥇ྲྀ 䛩䜛䚹⤌⧊ゎᯒ䛻䜘䜚䚸䛔䛛䛺䜛⅖⑕䝅䜾䝘䝹䛜䚸኱ ື⬦⒗䛾䛔䛛䛺䜛ሙᡤ䚸⑓ែ䝇䝔䞊䝆䛷άᛶ໬䛧䛶䛔䜛䛛䜢ゎᯒ䛩䜛䚹㻌㻌㻌㻌㻌㻌㻌 ᅗ 㻝㻚㻌 ኱ື⬦⒗䛿⅖⑕䛾䝍䜲䝮䜹䝥䝉䝹䛷䛒䜛㻌㻌㻌 ኱ື⬦⒗䛿ᖺ༢఩䛾㛗᫬㛫䛷㐍ᒎ䛧䚸⮫ᗋⓗ䛻䛿ᚄ䛾ᣑ኱䛷㐍ᒎ䛜ホ౯䛥䜜䛶䛔䜛䚹኱ື⬦⒗䛜㐍ᒎ䛩䜛㝿䛻䛿䚸ᶓᚄ䛾ᣑ኱䛸䛸䜒䛻㛗㍈᪉ྥ䠄ୖ ୗ᪉ྥ䠅䛻䜒㐍ᒎ䛧䛶䜖䛟䚹䛭䛾䛯䜑䚸ṇᖖ㒊䛛䜙⒗ 䜈䛾⛣⾜㒊䛿ᖖ䛻Ⓨ⑕ึᮇ䛷䛒䜚䚸⒗䛾᭱኱ᚄ௜ - 䠏䠊⤖ᯝ㻌㻌 ᮏ◊✲䛾ゎᯒ䛿䚸㻔㻝㻕㻌㐺ษ䛺㒊఩䛾⒗⤌⧊᥇ྲྀ䛸䝷䝧䝹௜䛡䚸㻔㻞㻕㻌 ⑓⌮ゎᯒ䛻䜘䜛ṇ☜䛺⑓ែ䝇䝔䞊䝆ศ㢮䚸㻔㻟㻕㻌 ศᏊ⑓ែ䛾ᢕᥱ䛾㻟 ⪅䛾᭷ᶵⓗ䛛䛴 ᐦ᥋䛺㐃ᦠ䛻䜘䜚ึ䜑䛶ྍ⬟䛻䛺䜛䚹௒ᖺᗘ䛿䚸䛣 228 - 䛾䝽䞊䜽䝣䝻䞊䜢స䜚ୖ䛢䛯䚹㻌㼀㼑㼚㼍㼟㼏㼕㼚㻌㻯㻌㻼㼞㼛㼠㼑㼏㼠㼟㻌㻭㼛㼞㼠㼕㼏㻌㼀㼕㼟㼟㼡㼑㻌㻲㼞㼛㼙㻌㻹㼡㼘㼠㼕㼜㼘㼑㻌㻌㻵㼚㼟㼡㼘㼠㼟㻌㻭㼓㼍㼕㼚㼟㼠㻌㼀㼔㼑㻌㻰㼑㼢㼑㼘㼛㼜㼙㼑㼚㼠㻌㼛㼒㻌㻭㼛㼞㼠㼕㼏㻌䠐䠊⪃ᐹ㻌㻭㼚㼑㼡㼞㼥㼟㼙㻌㻌 ኱ື⬦⒗䛾ศᏊ⑓ែゎ᫂䛾䛯䜑䛻䛿䚸༢䛻⤌⧊ 㻷㼕㼙㼡㼞㼍㻌㼀㻘㻌㼅㼛㼟㼔㼕㼙㼡㼞㼍㻌㻷㻘㻌㻭㼛㼗㼕㻌㻴䜋䛛㻌䝃䞁䝥䝹䜢཰㞟䛩䜛䛾䜏䛷䛿඘ศ䛷䛿䛺䛟䚸እ⛉ഃ 㻭㼙㼑㼞㼕㼏㼍㼚㻌㻴㼑㼍㼞㼠㻌㻭㼟㼟㼛㼏㼕㼍㼠㼕㼛㼚㻌㻿㼏㼕㼑㼚㼠㼕㼒㼕㼏㻌㻿㼑㼟㼟㼕㼛㼚㼟㻌㻞㻜㻜㻥㻌䛾᝟ሗ䠄⮫ᗋ᝟ሗ䚸⒗⤌⧊䛾఩⨨᝟ሗ䠅䚸⑓⌮⤌⧊ 㻺㼛㼢㼑㼙㼎㼑㼞㻌㻝㻠㻌㻙㻌㻝㻤㻘㻌㻞㻜㻜㻥㻚㻌㻻㼞㼘㼍㼚㼐㼛㻘㻌㻲㻸㻘㻌㼁㻿㻭㻚㻌㻌 Ꮫⓗ᝟ሗ䠄⤌⧊Ꮫⓗᵓ⠏䚸䝬䞊䜹䞊ศᏊ䛾Ⓨ⌧䠅䛸㼀㼑㼚㼍㼟㼏㼕㼚㻙㻯㻌㻴㼍㼟㻌㻭㻌㻼㼞㼛㼠㼑㼏㼠㼕㼢㼑㻌㻾㼛㼘㼑㻌㼐㼡㼞㼕㼚㼓㻌㼀㼔㼑㻌 ᭷ᶵⓗ䛻㛵㐃䛵䛡䜙䜜䛯ศᏊゎᯒ䛜㔜せ䛷䛒䜛䛸㻰㼑㼢㼑㼘㼛㼜㼙㼑㼚㼠㻌㼛㼒㻌㻭㼛㼞㼠㼕㼏㻌㻭㼚㼑㼡㼞㼥㼟㼙㻌㻌 ⪃䛘䜙䜜䛯䚹㻌㻷㼕㼙㼡㼞㼍㻌㼀㻘㻌㼅㼛㼟㼔㼕㼙㼡㼞㼍㻌㻷㻘㻌㻭㼛㼗㼕㻌㻴䜋䛛㻌㻌 ➨䠏䠎ᅇ᪥ᮏศᏊ⏕≀Ꮫ఍㻌䠑䠊⤖ㄽ㻌㻞㻜㻜㻥 ᖺ 㻝㻞 ᭶ 㻥 ᪥㻌㻙㻌㻝㻞 ᪥䠈ᶓ὾㻌㻌 ᮏ◊✲⌜䛾㈨※䜢⏕䛛䛧䚸኱ື⬦⒗䛾ศᏊ⑓ែ 䝽䞊䜽䝅䝵䝑䝥䛂៏ᛶ⅖⑕䠖⏕ά⩦័⑓䞉⒴䛻ඹ㏻䛩ゎᯒ䛻᭱㐺䛺䝽䞊䜽䝣䝻䞊䜢ᵓ⠏䛧ᐇാ䛥䛫䜛䛣䛸䛜䜛ᇶ┙⑓ែ䛃㻌䛷䛝䛯䚹㐺ษ䛺⑓⌮䝇䝔䞊䝆ศ㢮䜢ᵓ⠏䛧ศᏊゎᯒ ⅖⑕䛾䝍䜲䝮䜹䝥䝉䝹䠖኱ື⬦⒗䜢䝰䝕䝹⑌ᝈ䛸䛧䛸ᑐᛂ䛥䛫䜛䛣䛸䛷䚸ㅦ䛻ໟ䜎䜜䛯኱ື⬦⒗⑓ែ䛾䛯៏ᛶ⅖⑕䛾⑓ែゎ᫂㻌 ศᏊⓗグ㏙䛜ྍ⬟䛸ᛮ䜟䜜䜛䚹㻌㟷ᮌᾈᶞ䜋䛛㻌㻌 ➨䠓䠐ᅇ᪥ᮏᚠ⎔ჾᏛ఍㻌䠒䠊◊✲Ⓨ⾲ཬ䜃≉チ㻌㻞㻜㻝㻜 ᖺ 㻟 ᭶ 㻡㻌㻙㻌㻣 ᪥㻚㻌 ி㒔㻌㻻㼚㼛㼐㼍㻘㻌㻹䜋䛛㻚㻌㻞㻜㻜㻥㻚㻌㻸㼥㼟㼥㼘㻌㼛㼤㼕㼐㼍㼟㼑㻌㼞㼑㼟㼛㼘㼢㼑㼟㻌䝅䞁䝫䝆䜴䝮䛂኱ື⬦⑌ᝈ἞⒪㻌㼁㻼㻌㼠㼛㻌㻰㻭㼀㻱䛃㻌㼕㼚㼒㼘㼍㼙㼙㼍㼠㼕㼛㼚㻌㼎㼥㻌㼞㼑㼐㼡㼏㼕㼚㼓㻌㼙㼛㼚㼛㼏㼥㼠㼑㻌㼏㼔㼑㼙㼛㼍㼠㼠㼞㼍㼏㼠㼍㼚㼠㻌㻹㼛㼘㼑㼏㼡㼘㼍㼞㻌㻺㼑㼠㼣㼛㼞㼗㻌㼛㼒㻌㻭㼎㼐㼛㼙㼕㼚㼍㼘㻌㻭㼛㼞㼠㼕㼏㻌㻭㼚㼑㼡㼞㼥㼟㼙㻌㼜㼞㼛㼠㼑㼕㼚㻙㻝㻌㼕㼚㻌㼍㼎㼐㼛㼙㼕㼚㼍㼘㻌㼍㼛㼞㼠㼕㼏㻌㼍㼚㼑㼡㼞㼥㼟㼙㻚㻌㻭㼛㼗㼕㻌㻴䜋䛛㻌㻭㼠㼔㼑㼞㼛㼟㼏㼘㼑㼞㼛㼟㼕㼟㻚㻌㻔㼕㼚㻌㼜㼞㼑㼟㼟㻕㻌㻭㻌㻺㼛㼢㼑㼘㻌㻴㼥㼎㼞㼕㼐㻌㻰㼑㼢㼕㼏㼑㻌㼒㼛㼞㻌㻼㼑㼞㼟㼛㼚㼍㼘㼕㼦㼑㼐㻌㼍㼚㼐㻌㟷ᮌᾈᶞ㻘㻌 ྜྷᮧ⪔୍㻚㻌㻞㻜㻝㻜㻚㻌 ኱ື⬦⒗◊✲䛾⌧≧ 㻹㼕㼚㼕㼙㼍㼘㼘㼥㻌㻵㼚㼢㼍㼟㼕㼢㼑㻌㼀㼞㼑㼍㼠㼙㼑㼚㼠㻌㼛㼒㻌㻭㼛㼞㼠㼕㼏㻌㻭㼚㼑㼡㼞㼥㼟㼙㼟㻌䛸ㄢ㢟㻚㻌䛄ᚠ⎔ჾ⑌ᝈ䛾䝃䜲䜶䞁䝇䛅㻚㻌 ᑠᐊ୍ᡂ⦅㻚㻌㼅㼛㼟㼔㼕㼙㼡㼞㼍㻌㻷㻘㻌㻭㼛㼗㼕㻌㻴䜋䛛㻌 ᮾி㻦㻌 ༡ᒣᇽ㻚㻌㼀㼑㼚㼍㼟㼏㼕㼚㻙㻯㻌㻼㼞㼛㼠㼑㼏㼠㼟㻌㻭㼛㼞㼠㼕㼏㻌㼀㼕㼟㼟㼡㼑㻌㻲㼞㼛㼙㻌㻹㼡㼘㼠㼕㼜㼘㼑㻌 ྜྷᮧ⪔୍㻘㻌㟷ᮌᾈᶞ䜋䛛㻚㻌㻞㻜㻝㻜㻚㻌 ≉㞟䛂኱ື⬦⑌ᝈ 㻵㼚㼟㼡㼘㼠㼟㻌㻭㼓㼍㼕㼚㼟㼠㻌㼀㼔㼑㻌㻰㼑㼢㼑㼘㼛㼜㼙㼑㼚㼠㻌㼛㼒㻌㻭㼛㼞㼠㼕㼏㻌䇶኱ື⬦ゎ㞳䛸⬚⭡㒊኱ື⬦⒗䠖デ᩿䛸἞⒪䛾㐍㻭㼚㼑㼡㼞㼥㼟㼙㻌 Ṍ䛃㻌㻶㻺㻷 άᛶ໬䛸኱ື⬦⑌ᝈ㻚㻌 ᪥ᮏෆ⛉Ꮫ఍㞧ㄅ㻌㻷㼕㼙㼡㼞㼍㻌㼀㻘㻌㼅㼛㼟㼔㼕㼙㼡㼞㼍㻌㻷㻘㻌㻭㼛㼗㼕㻌㻴䜋䛛㻌㻥㻥㻦㼕㼚㻌㼜㼞㼑㼟㼟㻚㻌 ➨ 㻠㻝 ᅇ᪥ᮏື⬦◳໬Ꮫ఍㻌㟷ᮌᾈᶞ㻚㻌㻞㻜㻜㻥㻚㻌 ≉㞟䛂኱ື⬦⒗䛾ศᏊ⣽⬊⏕≀ 㻞㻜㻜㻥 ᖺ 㻣 ᭶ 㻝㻣㻌㻙㻌㻝㻤 ᪥㻘㻌 ୗ㛵㻌 Ꮫ䛃䠄௻⏬ᢸᙜ䠅㻚㻌⾑⟶་Ꮫ㻌㻝㻜㻦㻣㻙㻣㻝㻚㻌㻿㼥㼙㼜㼛㼟㼕㼡㼙㻌㻎㻾㼑㼏㼑㼚㼠㻌㼍㼐㼢㼍㼚㼏㼑㼟㻌㼕㼚㻌㼜㼍㼠㼔㼛㼎㼕㼛㼘㼛㼓㼥㻌㼍㼚㼐㻌 ྜྷᮧ⪔୍㻘㟷ᮌᾈᶞ䜋䛛㻚㻌㻞㻜㻜㻥㻚㻌䛂⮫ᗋ䛸ᇶ♏䛾᥋ 㼠㼞㼑㼍㼠㼙㼑㼚㼠㻌㼛㼒㻌㼍㼛㼞㼠㼕㼏㻌㼍㼚㼑㼡㼞㼥㼟㼙㼟㻎㻌 Ⅼ䛃⾑⟶་Ꮫ㻌㻝㻜㻦㻝㻟㻙㻝㻥㻚㻌㻹㼛㼘㼑㼏㼡㼘㼍㼞㻌㻼㼍㼠㼔㼛㼓㼑㼚㼑㼟㼕㼟㻌㼛㼒㻌㻭㼎㼐㼛㼙㼕㼚㼍㼘㻌㻭㼛㼞㼠㼕㼏㻌㻭㼙㼑㼞㼕㼏㼍㼚㻌㻿㼛㼏㼕㼑㼠㼥㻌㼒㼛㼞㻌㻯㼑㼘㼘㻌㻮㼕㼛㼘㼛㼓㼥㻌㻭㼚㼚㼡㼍㼘㻌㻹㼑㼑㼠㼕㼚㼓㻌㻭㼚㼑㼡㼞㼥㼟㼙㻚㻌㻞㻜㻜㻥㻌㻴㻚㻭㼛㼗㼕㻘㻌㻷㻚㻌㼅㼛㼟㼔㼕㼙㼡㼞㼍㻘㻌㻴㻚㻌䜋䛛㻌㻰㼑㼏㼑㼙㼎㼑㼞㻌㻡㻌㻙㻌㻥㻘㻌㻞㻜㻜㻥㻚㻌㻿㼍㼚㻌㻰㼕㼑㼓㼛㻘㻌㻯㻭㻘㻌㼁㻿㻭㻚㻌㻌 - 229 - 㸦21 ᣦ 117㸧ᑠᚄ⒗ࡢ⮬↛Ṕㄪᰝࠊゎᯒ ศᢸ◊✲⪅㸸ྜྷᮧ⪔୍ 㸯㸬┠ⓗ ࡚ࠊ⏕ά⩦័⑓࡛ぢࡽࢀࡿྛ✀௦ㅰ␗ᖖ㸦⬡ ኱ ື⬦ ⒗࡟ ᑐࡍ ࡿ᭷ຠ ࡞ ἞⒪ ἲࡀ ౵く ⓗ ㉁௦ㅰ␗ᖖࠊ㧗⾑ᅽࠊ⪏⢾⬟㞀ᐖࠊ⫧‶➼㸧ࠊ ࡞ እ ⛉ⓗ ⒪ἲ ࡋ࠿ ࡞࠸⌧ ≧ ࡛ࡣ ࠊᑠ ᚄ኱ ື ༴ 㝤 ᅉᏊ 㸦ᖺ 㱋ࠊ ႚ↮➼ 㸧 ࠶ࡿ ࠸ࡣ ᝈ⪅ ⫼ ⬦ ⒗ 㸦௨ ୗࠊ ᑠᚄ ⒗㸧ࡣ ἞ ⒪ࡢ 㐺ᛂ ࠿ࡽ እ ᬒ 㸦 ྜే ⑌ᝈ ࠊᐙ ᪘Ṕ㸧 ࡜ ⒗ᚄ ᣑ኱ ㏿ᗘ ࡢ ࢀ ࡚ ࠸ࡿ ࠋࡋ ࠿ࡋ ࡞ࡀࡽ ࠊ ᨺ⨨ ࡍࢀ ࡤ㐜 ࠿ 㛵㐃 ࢆゎ ᯒࡍ ࡿࠋ ࡲࡓࠊ ᮏ ◊✲ ᳨࡛ ウࡍ ࡿ ࢀ ᪩ ࠿ࢀ ᣑ኱ ࡋ◚ ⿣Ṛ࡟ ⮳ ࡿࡇ ࡢᑠ ᚄ⒗ ࡢ ᪂ ࡓ ࡞ ⑓ែ デ ᳨᩿ ᰝ ἲ㸦 )'*3(7 ࠾ ࡼ ࡧ ⾑ ₯ ᅾ ⓗᝈ ⪅ᩘ ࡣᡭ ⾡㐺ᛂ ࡜ ࡞ࡿ ኱ᚄ ኱ື ⬦ Ύ ࢸ ࢿ࢖ ࢩࣥ 㹁್ 㸧࡜⒗ ᚄ ᣑ኱ ㏿ᗘ ࡜ࡢ 㛵 ⒗ ࡢ ࡶࡢ ࢆࡣ ࡿ࠿ ࡟෽ࡄ ࡜ ᥎ ࡉࢀ ࠊࡑ ࡢ 㐃ゎ ᯒࢆ ௚ࡢ ศᢸ◊ ✲ ⪅ ࡜༠ ຊࡋ ࡚⾜ ࡞࠺ࠋ ᑐ ᛂ ⟇ࢆ ᅗࡿ ࡇ࡜ ࡣᛴົ ࡛ ࠶ࡿ ࠋᮏ ◊✲ ඲ ࡞ ࠾ࠊ ᝈ⪅ Ⓩ㘓 ࡟࠶ࡓ ࡗ ࡚ࡣ ྛ᪋ タࡢ ೔ య ࡛ ࡣࠊ ᑠᚄ ⒗ࢆ ⏕ά⩦ ័ ⑓ࡢ ᯟ⤌ ࡳ࡛ ᤊ ⌮ ጤ ဨ఍ 㸧ࡢ ᢎㄆ ࢆᚓࡓ ୖ ࡛ࠊ ᝈ⪅ ᮏே ࡬ ࠼ ┤ ࡍࡇ ࡜࡟ ࡼࡾ ࠊᑠᚄ ⒗ ࡟ᑐ ࡍࡿ ⑓ែ デ ࡢ ㄝ ᫂ᚋ ࡟⮬ ⏤ព ᛮ࡟ࡼ ࡿ ᢎㅙ ࢆᩥ ᭩࡛ ᚓ ᩿ ࣭ ἞⒪ ἲࢆ ᪂つ ࡟᳨ウ ࡋ ࠊࡇ ࢀ࡟ ࡼࡗ ࡚ ࡚ ᐇ ᪋ࡍ ࡿࡶ ࡢ࡜ ࡍࡿࠋ ࡉ ࡽ࡟ ࠊᝈ ⪅᝟ ሗ ኱ື⬦⒗ᝈ⪅඲యࡢணᚋ࡜ 42/ ࢆྥୖࡉࡏ ࡣ 㐃 ⤖ྍ ⬟࡞ ༏ྡ ໬ฎ⌮ ࢆ ⾜࡞ ࡗࡓ ᚋ࡟ ࠊ ࡿ ࡜ ࡜ࡶ ࡟ࠊ ་⒪ ㈝๐ῶ ࡟ ࡶ㈉ ⊩ࡍ ࡿࡇ ࡜ ಶே᝟ሗ࡜⮫ᗋ᝟ሗࢆศࡅ࡚ಖ⟶ࡍࡿࠋ ࢆ ┠ ⓗ࡜ ࡍࡿ ࠋ≉ ࡟ᮏศ ᢸ ◊✲ ࡛ࡣ ࠊᮏ 㑥 ࡟ ࠾ ࠸࡚ ᑠᚄ ⒗ࡢ ⮬↛Ṕ ࢹ ࣮ࢱ ࡀᴟ ࡵ࡚ ஈ 㸱㸬⤖ᯝ ࡋ ࠸ ࡇ࡜ ࡟╔ ┠ࡋ ࠊᮏ㑥 ᑠ ᚄ⒗ ࡢ⮬ ↛Ṕ ࢆ ศ ᢸ◊ ✲⪅ ࡟༠ ຊࡋ࡚ ࠊ ྛ᪋ タ㸦 ᅜ❧ ᅜ ゎ ᯒ ࡋࡑ ࡢ≉ ᚩࢆ ᤊ࠼ࠊ ண 㜵࣭ デ᩿ ࣭἞ ⒪ 㝿 ་ ⒪ࢭ ࣥࢱ ࣮୪ ࡧ࡟ᮾ ி ་⛉ ኱Ꮫ 㸧࡟ ࠾ ࡬฼⏝ࡍࡿࡇ࡜ࢆ┠ⓗ࡜ࡍࡿࠋ ࡅࡿ೔⌮ጤဨ఍⏦ㄳ࡟㛵ࢃࡾࠊᢎㄆࢆᚓࡓࠋ ྠ ᫬ ࡟ࠊ ⑕౛ Ⓩ㘓 ⏝ࢹ࣮ ࢱ ࣮࣋ ࢫࡢ స〇 ࡟ 㸰㸬᪉ἲ ࡶ ༠ ຊࡋ ࠊ᏶ ᡂࡉ ࡏࡓࠋ ࡇ ࢀࡽ ࡟ࡼ ࡾࠊ ᅜ ௚ ࡢศ ᢸ◊ ✲⪅ ࡜༠ຊ ࡋ ࡚ᑠ ᚄ⒗ ⑕౛ ࢆ ❧ᅜ㝿་⒪ࢭࣥࢱ࣮࡛ࡣᖹᡂ ᖺ ᭶࠿ Ⓩ 㘓 ࡋࠊ ྛ✀ ᳨ウ㡯┠ࡢ ࢹ ࣮ࢱ ࢆ᥇ ྲྀࡋ ࡞ ࡽⓏ㘓ࢆ㛤ጞࡋࠊᖹᡂ ᖺ ᭶ࡲ࡛࡟ ࡀ ࡽ ⤒㐣ほᐹ ࡋࠊ ⮬↛Ṕ ࢆ ㄪᰝ ࡍࡿ ࠋࡉ ࡽ ⑕ ౛ ࡀⓏ 㘓ࡉ ࢀࡓ ࠋࡇࢀ ࡟ ຍ࠼ ࡚ࠊ ᮾி ་ ࡟ ࠊ ⤫ィ Ꮫⓗ ゎᯒ ࡟ࡼࡗ ࡚ ࠊᑠ ᚄ⒗ ࡢ⮬ ↛ ⛉ ኱ Ꮫ࡟ ⣙ ேࡢ Ⓩ㘓 ண ᐃᝈ ⪅ࡀ ᚅ ᶵ୰ Ṕࡢ≉ᚩࢆᢳฟࡍࡿࠋ ࡛࠶ࡿࠋ ᑐ㇟ࡣࠊ⒗ᚄ ࠥPP ࡢ⭡㒊኱ື⬦⒗࡞ ⌧ ᅾࡢ ࡜ࡇ ࢁࠊ Ⓩ㘓㛤 ጞ ࠿ࡽ ࡢ⤒ 㐣ࡀ ▷ ࡽ ࡧ ࡟ ⒗ᚄ ࠥ PP ࡢ ⬚ 㒊 ኱ື ⬦⒗ ࢆ ᭷ ࡃ ࠊ ྛ✀ ᳨ウ㡯┠ ࡢࢹ࣮ ࢱ 㞟ィ ࠶ࡿ ࠸ࡣ ゎ ࡍࡿᝈ⪅࡜ࡍࡿࠋᖺ㱋ࡣ ṓ࠿ࡽ ṓᮍ ᯒ ࡟ ࡣ⮳ ࡗ࡚ ࠸࡞ ࠸ࠋࡋ ࠿ ࡋ࡞ ࡀࡽ ࠊᝈ ⪅ ‶ࡲ࡛࡜ࡍࡿࠋึᖺᗘཬࡧḟᖺᗘ࡛ ⑕౛ ᝟ ሗ ಖㆤ ྍ⬟ ࡞ࢹ ࣮ࢱ㞟ィ ࡞ࡽ ࡧ࡟ ྛ✀ ᳨ ࡢ Ⓩ 㘓ࢆ ┠ᶆ ࡜ࡍ ࡿࠋ୍ ḟ ホ౯ 㡯┠ ࡣࠊ ༙ ウ㡯 ┠ࢹ ࣮ࢱ ࡢ⤫ ィᏛⓗ ゎ ᯒࢆ ࡍࡄ ࡟࡛ ࡶ ᖺ ẖ ࡢ㐀 ᙳ &7 ᳨ᰝ ࡟ࡼ ࡿ ⒗ᚄ ࡞ࡽ ࡧ ࡟ᣑ ᐇ ᪋ ࡛ࡁ ࡿࡼ ࠺࡟ ࠊᮏ◊ ✲ 㛤ጞ ᚋ⌧ ᅾࡲ ࡛ ኱ ㏿ ᗘ࡛ ࠶ࡿ ࠋࡉ ࡽ࡟ࠊ ஧ ḟホ ౯㡯 ┠࡜ ࡋ ࡟ࢩࢫࢸ࣒ࢆᩚഛࡋ⤊࠼ࡓࠋ - 230 - 㸲㸬⪃ᐹ ࡚ ࡟ 㛵ࢃ ࡿ༴ 㝤ᅉ Ꮚ࡛࠶ ࡾ ࠊ⚗ ↮࡟ ࡼࡿ ⒗ ኱ ື⬦ ⒗ࡣ ࠊ↓ ⑕≧ࡢ ࡲ ࡲ㐍⾜ࡋ ᨺ⨨ ࡍ ᚄᣑ኱ࡢ㍍ῶຠᯝࡀሗ࿌ࡉࢀ࡚࠸ࡿࠋࡲࡓࠊ ࢀ ࡤ ◚⿣ Ṛ࡟ ⮳ࡿ ࠋࡇࡢ ◚ ⿣Ṛ ࢆᅇ 㑊ࡍ ࡿ ࢫࢱࢳࣥࡸ $&( 㜼ᐖ๣ࡣࠊࡍ࡛࡟⮫ᗋࡢሙ ࡇ ࡜ ࡀ኱ ື⬦ ⒗἞ ⒪ࡢ┠ ⓗ ࡛࠶ ࡿࠋ ⌧ᅾ ࠊ ࡛ ฼ ⏝ࡉ ࢀᚰ ⾑⟶ ࣜࢫࢡ ࢆ ㍍ῶ ࡍࡿ ࡇ࡜ ࡀ ኱ ᚄ ኱ື ⬦⒗ ࡟ᑐ ࡋ࡚ࡢ ࡳ ≀⌮ ⓗ࡟ ◚⿣ ࢆ ▱ ࡽ ࢀ࡚ ࠸ࡿ ࡀࠊ ኱ື⬦ ⒗ ࡟ᑐ ࡍࡿ ຠᯝ ࡶ 㜵 Ṇ ࡍࡿ እ⛉ ⓗ⒪ ἲ࡟ࡼ ࡗ ࡚἞ ⒪ࡉ ࢀ࡚ ࠸ ྠ ᫬ ࡟ࡶ ᮇᚅ ࡉࢀ ࡚࠾ࡾ ࠊ ᭷ᮃ どࡉ ࢀ࡚ ࠸ ࡿ ࠋ ࡋ࠿ ࡋࠊ ኱ື ⬦⒗࡟ ࡼ ࡿ◚ ⿣Ṛ ࡣࢫ ࢸ ࡿ⸆≀⒪ἲ࡜⪃࠼ࡽࢀࡿࠋ ࣥ ࢺ ࢢࣛ ࣇࢺ ἞⒪ ࢆྵࡵ ࡓ እ⛉ ⓗ἞ ⒪ࡢ ⴭ ࡋ ࠸ 㐍Ṍ ࡟ࡶ 㛵ࢃ ࡽࡎࠊ ౫ ↛࡜ ࡋ࡚ 㧗㱋 ⪅ 㸳㸬⤖ㄽ Ṛ ஸ ཎᅉ ࡢୖ ఩࡟ ࣛࣥࢡ ࡉ ࢀ࡚ ࠸ࡿ ࠋࡇ ࢀ ᮏ ◊✲ ࡣࠊ ⌧ᅾ ᭷ຠ࡞ ἞ ⒪ἲ ࡀ࡞ ࠸ᑠ ᚄ ࡣ ࠊ ⌧ᅾ ࡢ἞ ⒪ἲ ࡀ◚⿣ ࣜ ࢫࢡ ࡢ㧗 ࠸኱ ᚄ ⒗ ࢆ ⏕ά ⩦័ ⑓ࡢ ᯟ⤌ࡳ ࡛ ᤊ࠼ ┤ࡋ ࠊࡑ ࡢ ⒗ ࡢ ࡳ࡟ ᭷ຠ ࡞ࡶ ࡢ࡛࠶ ࡗ ࡚ࠊ ࡑࡢ ᩘ࡛ ኱ ⮫ ᗋ ⓗ≉ ᚩ࡜ ⑓ែ ࢆゎ᫂ ࡍ ࡿࡇ ࡜࡟ ࡼࡾ ࠊ ᚄ ⒗ ᝈ⪅ ࢆࡣ ࡿ࠿ ࡟෽ࡄ ࡜ ᥎ᐹ ࡉࢀ ࡿᑠ ᚄ ᪂ ࡓ ࡞ෆ ⛉ⓗ ⒪ἲ ࢆ☜❧ ࡋ ࡼ࠺ ࡜ࡍ ࡿࡶ ࡢ ⒗ ᝈ ⪅࡟ ᑐࡋ ࡚ࡣ ࠊ⤒㐣ほ ᐹࡍ ࡿࡼ ࡾ௚ ࡟ ࡛ ࠶ ࡿࠋ ≉࡟ ᮏศ ᢸ◊✲ ࡛ ࡣࠊ ᑠᚄ ⒗ࡢ ⮬ ⾡ ࡀ ࡞࠸ ࡇ࡜ ࡀ኱ ࡁࡃ㛵 ୚ ࡋ࡚ ࠸ࡿ ࡟㐪 ࠸ ↛ Ṕ ࡟࠾ ࡅࡿ ⒗ᚄ ᣑ኱㏿ ᗘ ࡜ྛ ✀⮫ ᗋࢹ ࣮ ࡞ ࠸ ࠋ⑓ ែࡸ ᡂᅉ ࡟ᇶ࡙ ࠸ ࡓෆ ⛉ⓗ ⒪ἲ ࢆ ࢱ ࡜ ࡢ㛵㐃ࢆ ศᯒ ࡋࠊᑠ ᚄ ⒗ࡢ ᣑ኱ せᅉ ࢆ ☜ ❧ ࡍࡿ ࡇ࡜ ࡀษᮃ ࡉࢀ ࡚࠸ ࡿᡤ ௨࡛ ࠶ࡿ ࠋ ᥈ ồ ࡍࡿ ࠋࡑ ࡢࡓ ࡵࡢࠊ ⑕ ౛Ⓩ 㘓ࡣ ᮏ◊ ✲ ࡲ ࡓ ࠊ⏕ άᵝ ᘧࡢ Ḣ⡿໬ ࡜ ㉸㧗㱋໬ ♫఍ ࡢ ᮇ 㛫 ୰࡛ ᪤࡟ 㛤ጞ ࡉࢀࠊ ࢹ ࣮ࢱ ཰㞟 ୪ࡧ ࡟ ฿ ᮶ ࡟ࡼ ࡗ࡚ ࠊࡉ ࡽ࡞ࡿ ᝈ ⪅ᩘ ࡜ᡭ ⾡ᩘ ࡢ ゎ ᯒ ࡢ‽ ഛࡶ ᩚࡗ ࡓࠋ௒ ᚋ ࡣィ ⏬࡝ ࠾ࡾ ࡟ ቑ ຍ ࡣᚲ Ṛ࡛ ࠶ࡾ ࠊᅜẸ ࡢ ೺ᗣ ࢆᐖ ࡍࡿ ࡤ Ⓩ 㘓 ⑕౛ ࢆ㔜 ࡡ࡚ ゎᯒࡋ ࠊ ᐇ㝿 ࡢ኱ ື⬦ ⒗ ࠿ ࡾ ࡛࡞ ࡃ་ ⒪㈝㈇ ᢸࡶ ቑࡍ ࡤ࠿ ࡾ࡛ ࠶ࡿ ࠋ デ ⒪ ࡟㑏 ඖ࡛ ࡁࡿ ࡼ࠺࡞ ▱ ぢࢆ ᚓࡿ ணᐃ ࡛ ௒ ࡇ ࡑࠊ ᑠᚄ ⒗࡟ ᑐࡍࡿ ↓ ౵く ࠿ࡘ పࢥ ࢫ ࠶ࡿࠋ ࢺ ࡢ ண㜵 ࣭἞ ⒪ࢩ ࢫࢸ࣒ ࢆ 㛤Ⓨ ࡋࠊ ⌧ᅾ ࡢ እ ⛉ ⓗ⒪ ἲ࡟ ୪ࡪ ෆ⛉ⓗ ⒪ ἲࢆ デ⒪ ࡢ⌧ ሙ 㸴㸬◊✲Ⓨ⾲ཬࡧ≉チ ࡛ᐇ⏝໬ࡍࡿᚲせࡀ࠶ࡿ࡜⪃࠼ࡽࢀࡿࠋ ヱᙜ࡞ࡋࠋ ᭱ ㏆ᮏ 㑥࡛ ࡣࠊ ᚰ⾑⟶ ࣜ ࢫࢡ ࢆቑ ኱ࡍ ࡿ 㧗⾑ ᅽ࣭ 㧗⬡ ⾑⑕ ➼ࡢ⏕ ά ⩦័ ⑓ࢆ ࡑࡢ ๓ ẁ 㝵 ࡛࣓ ࢱ࣎ ࣜࢵ ࢡ⑕ೃ ⩌ ࡜ࡋ ࡚࡜ ࡽ࠼ ࠊ ᪩ ᮇ ࡟Ⓨ ぢண 㜵ࡍ ࡿࡇ࡜ ࡀ ┒ࢇ ࡟ၐ ࠼ࡽ ࢀ ࡚ ࠸ ࡿࠋ ኱ື ⬦⒗ ࡟࠾࠸ ࡚ ࡶྠ ᵝ࡟ ࠊ⒗ Ⓨ ⑕ ࡢ 㧗ࣜ ࢫࢡ ⪅ࢆ ᑐ㇟࡜ ࡋ ࡓࢫ ࢡࣜ ࣮ࢽ ࣥ ࢢ ᳨ ᰝࢆ ᐇ᪋ ࡋ ᪩ ᮇⓎぢ ࡟ ດࡵ ࠊ᪩ ᮇࡢ ᑠ ᚄ ⒗ ᝈ⪅ ࡟ᑐ ࡋ⏕ ά⩦័ ࡢ ᨵၿ ࡸ⸆ ≀⒪ ἲ ࡟ ࡼ ࡗ࡚ ↓౵ く࠿ ࡘపࢥ ࢫ ࢺ࡟ ⒗ᣑ ኱㜵 Ṇ ࢆ ᅗ ࡿࡇ ࡜ࡀ ᚲせ ࡛ࡣ࡞ ࠿ ࢁ࠺ ࠿ࠋ ᐇ㝿 ࠊ ႚ ↮ ࡣ኱ ື⬦ ⒗ࡢ Ⓨ⏕ࠊ ᣑ ኱ࠊ ◚⿣ ࡢࡍ ࡭ - 231 -